External validation of the HCC-MELD score for patients with hepatocellular carcinoma waiting for liver transplantation

2017 ◽  
Vol 49 (1) ◽  
pp. e10
Author(s):  
A. Vitale ◽  
A.C. Frigo ◽  
P. Burra ◽  
P. Angeli ◽  
G. Zanus ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
External Validation ◽  
Meld Score

scholarly journals A preoperative nomogram predicts prognosis of patients with hepatocellular carcinoma after liver transplantation: a multicenter retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dabing Huang ◽  
Yinan Shen ◽  
Wei Zhang ◽  
Chengxiang Guo ◽  
Tingbo Liang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Adjuvant Therapy ◽  
Validation Cohort ◽  
Multivariate Analyses ◽  
Meld Score ◽  
Blood Type ◽  
Intermediate Risk ◽  
Final Model ◽  
Using Data

Abstract Background Although criteria for liver transplantation, such as the Milan criteria and Hangzhou experiences, have become popular, criteria to guide adjuvant therapy for patients with hepatocellular carcinoma after liver transplantation are lacking. Methods We collected data from all consecutive patients from 2012 to 2019 at three liver transplantation centers in China retrospectively. Univariate and multivariate analyses were used to analyze preoperative parameters, such as demographic and clinical data. Using data obtained in our center, calibration curves and the concordance Harrell’s C-indices were used to establish the final model. The validation cohort comprised the patients from the other centers. Results Data from 233 patients were used to construct the nomogram. The validation cohort comprised 36 patients. Independent predictors of overall survival (OS) were identified as HbeAg positive (P = 0.044), blood-type compatibility unmatched (P = 0.034), liver transplantation criteria (P = 0.003), and high MELD score (P = 0.037). For the validation cohort, to predict OS, the C-index of the nomogram was 0.874. Based on the model, patients could be assigned into low-risk (≥ 50%), intermediate-risk (30–50%), and high-risk (≤ 30%) groups to guide adjuvant therapy after surgery and to facilitate personalized management. Conclusions The OS in patients with hepatocellular carcinoma after liver transplantation could be accurately predicted using the developed nomogram.

scholarly journals Reduced Priority MELD Score for Hepatocellular Carcinoma Does Not Adversely Impact Candidate Survival Awaiting Liver Transplantation

2006 ◽  
Vol 6 (8) ◽  
pp. 1957-1962 ◽  
Author(s):  
P. Sharma ◽  
A. M. Harper ◽  
J. L. Hernandez ◽  
T. Heffron ◽  
D. C. Mulligan ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Meld Score

The effect of bridging locoregional therapies on survival in hepatocellular carcinoma patients undergoing orthotopic liver transplantation: UNOS population study.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 346-346 ◽  
Author(s):  
Minzhi Xing ◽  
Hyun Sik Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Large Scale ◽  
Population Based ◽  
Meld Score ◽  
Kaplan Meier ◽  
Comparison Groups ◽  
Locoregional Therapies ◽  
End Stage

346 Background: The effect of bridging locoregional therapies (LRT) on overall survival (OS) in pts with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT) has not been investigated in large-scale population studies. Methods: TheUnited Network for Organ Sharing (UNOS) database was used to identify pts with HCC who received OLT between 2002 and 2010. Pts within Milan Criteria for whom an HCC Model for End-Stage Liver Disease (MELD) exception was approved were included. OS was compared between pts who received bridging LRT (including transarterial chemoembolization (TACE)) and those who did not. Kaplan-Meier estimation and Cox proportional hazard models were used for OS analysis. Results: Of 11,287 pts with HCC who received OLT, 9,876 pts had LRT data, mean age 56.6 yrs, 77% male; 5,103 received bridging LRT, including 3,676 who received TACE. Comparison groups were similar for age at OLT, waitlist duration, sex, race, BMI and MELD score (p>.05 for all). Significantly prolonged OS with bridging LRT vs. none was observed from both OLT (111.6 vs 106.4 mo, p<.001) and from Listing (176.1 vs 169.4 mo, p=.001). Similarly, significantly prolonged OS with bridging TACE vs. none was observed from both OLT (112.0 vs 107.2 mo, p<.001) and from Listing (177.7 vs 169.9 mo, p=.001). Conclusions: In HCC pts undergoing OLT, both bridging LRT and TACE correlated with prolonged survival from OLT and from Listing in a UNOS population-based study. [Table: see text]

scholarly journals Liver Transplantation for T2 Hepatocellular Carcinoma during the COVID-19 Pandemic: A Novel Model Balancing Individual Benefit against Healthcare Resources

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1416
Author(s):  
Umberto Cillo ◽  
Alessandro Vitale ◽  
Michael L. Volk ◽  
Anna Chiara Frigo ◽  
Paolo Feltracco ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Quantitative Model ◽  
Meld Score ◽  
Waiting List ◽  
Ethical Framework ◽  
Organ Shortage ◽  
Net Benefit ◽  
The Individual ◽  
End Stage

The COVID-19 pandemic caused temporary drops in the supply of organs for transplantation, leading to renewed debate about whether T2 hepatocellular carcinoma (HCC) patients should receive priority during these times. The aim of this study was to provide a quantitative model to aid decision-making in liver transplantation for T2 HCC. We proposed a novel ethical framework where the individual transplant benefit for a T2 HCC patient should outweigh the harm to others on the waiting list, determining a “net benefit”, to define appropriate organ allocation. This ethical framework was then translated into a quantitative Markov model including Italian averages for waiting list characteristics, donor resources, mortality, and transplant rates obtained from a national prospective database (n = 8567 patients). The net benefit of transplantation in a T2 HCC patient in a usual situation varied from 0 life months with a model for end-stage liver disease (MELD) score of 15, to 34 life months with a MELD score of 40, while it progressively decreased with acute organ shortage during a pandemic (i.e., with a 50% decrease in organs, the net benefit varied from 0 life months with MELD 30, to 12 life months with MELD 40). Our study supports the continuation of transplantation for T2 HCC patients during crises such as COVID-19; however, the focus needs to be on those T2 HCC patients with the highest net survival benefit.

scholarly journals MELD-Sarcopenia is Better than ALBI and MELD Score in Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation

2021 ◽  
Vol 22 (7) ◽  
pp. 2005-2009
Author(s):  
Ayman Alsebaey ◽  
Aliaa Sabry ◽  
Hanaa Rashed ◽  
Maha Elsabaawy ◽  
Amr Ragab ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Meld Score ◽  
Better Than

Survival Benefit of Liver Transplantation Versus Resection for Hepatocellular Carcinoma: Impact of MELD Score

2014 ◽  
Vol 22 (6) ◽  
pp. 1901-1907 ◽  
Author(s):  
Alessandro Vitale ◽  
Teh-la Huo ◽  
Alessandro Cucchetti ◽  
Yun-Hsuan Lee ◽  
Michael Volk ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Survival Benefit ◽  
Meld Score

scholarly journals Preoperative Alfa-Fetoprotein and Fibrinogen Predict Hepatocellular Carcinoma Recurrence After Liver Transplantation Regardless of the Milan Criteria: Model Development with External Validation

2018 ◽  
Vol 48 (1) ◽  
pp. 317-327 ◽  
Author(s):  
Nan Jiang ◽  
Kai-Ning Zeng ◽  
Ke-Feng Dou ◽  
Yi Lv ◽  
Jie Zhou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
External Validation ◽  
Model Development ◽  
Area Under The Curve ◽  
Disease Free Survival ◽  
Milan Criteria ◽  
Cutoff Score ◽  
Fibrinogen Concentration ◽  
Patient Prognosis

Background/Aims: Patient selection is critically important in improving the outcomes of liver transplantation for hepatocellular carcinoma. The aim of the current study was to identify biochemical measures that could affect patient prognosis after liver transplantation. Methods: A total of 119 patients receiving liver transplantation for hepatocellular carcinoma were used to construct a model for predicting recurrence. The results were validated using an independent sample of 109 patients from independent hospitals. All subjects in both cohorts met the Hangzhou criteria. Results: Analysis of the discovery cohort revealed an association of recurrence with preoperative fibrinogen and AFP levels. A mathematical model was developed for predicting probability of recurrence within 5 years: Y = logit(P) = -4.595 + 0.824 ×fibrinogen concentration (g/L) + 0.641 × AFP score (1 for AFP<=20ng/ml, 2 for 20<AFP<=100ng/ml, 3 for 100<AFP<=200ng/ml, 4 for 200<AFP<=400ng/ml, 5 for AFP> 400ng/ml). At a cutoff score of -0.85, the area under the curve (AUC) was 0.819 in predicting recurrence (vs. 0.655 when using the Milan criteria). In the validation cohort, this model had reasonable performance in predicting 5-year overall survival (68.8% vs. 28.1% in using the -0.85 cutoff, p< 0.001) and disease-free survival (65.7% vs. 25.9%, p< 0.001). The sensitivity and specificity were 77.0% and 62.5%, respectively. The AUC of this newly developed model was similar to that with the Milan criteria (0.698 vs. 0.678). Surprisingly, the DFS in patients with score <= -0.85 under this model but not meeting the Milan criteria was similar to that in patients meeting the Milan criteria (53.8% vs. 60.0%, p=0.380). Conclusions: Preoperative AFP and fibrinogen are useful in predicting recurrence of hepatocellular carcinoma after liver transplantation.

Sign in / Sign up

Export Citation Format

Share Document