Child-Pugh score
A score of how well a damaged liver is still working, from five simple measures (bilirubin, albumin, clotting, fluid in the abdomen, confusion). Class A is well compensated, C is failing. Liver cancer trials almost all require class A.
Because hepatocellular carcinoma nearly always arises in cirrhosis, the liver's reserve determines whether a patient can survive resection, tolerate TACE or radioembolisation, or be given systemic therapy, and it competes with the cancer as a cause of death. Almost every phase 3 trial in liver cancer enrolled Child-Pugh A patients only, so evidence in class B is thin. The ALBI grade (albumin and bilirubin only) is a more objective alternative used in modern trials and in the BCLC algorithm.
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