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

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.

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

10.21203/rs.3.rs-32861/v1 ◽

2020 ◽

Author(s):

Dabing Huang ◽

Yinan Shen ◽

Wei Zhang ◽

Chengxiang Guo ◽

Xueli Bai ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Adjuvant Therapy ◽

Validation Cohort ◽

Multivariate Analyses ◽

Meld Score ◽

Blood Type ◽

Intermediate Risk ◽

Final Model ◽

Using Data

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Race/Ethnicity Is Not Independently Associated with Risk of Adverse Waitlist Removal among Patients with HCC Exception Points

Journal of Clinical Medicine ◽

10.3390/jcm10245826 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5826

Author(s):

Daniela Goyes ◽

John Paul Nsubuga ◽

Esli Medina-Morales ◽

Romelia Barba ◽

Vilas Patwardhan ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

College Education ◽

Meld Score ◽

Clinical Deterioration ◽

Blood Type ◽

Racial Groups ◽

Liver Transplants ◽

Final Model ◽

Race Ethnicity ◽

United Network

(1) Background: Since 2015, exception points have been awarded to appropriate candidates after six months of waitlist time to allow more equitable access to liver transplants regardless of hepatocellular carcinoma status. However, it remains unknown whether racial disparities in outcomes among waitlisted patients remain after the introduction of a 6-month waiting period for exception points. (2) Methods: Using the United Network for Organ Sharing database, we identified 2311 patients diagnosed with hepatocellular carcinoma listed for liver transplant who received exception points from 2015 to 2019. The outcome of interest was waitlist survival defined as the composite outcome of death or removal for clinical deterioration. Competing risk analysis was used to identify factors associated with death or removal for clinical deterioration. The final model adjusted for age, sex, race/ethnicity, blood type, diabetes, obesity, laboratory MELD score, tumor size, AFP, locoregional therapies, UNOS region, and college education. (3) Results: No difference was found in the risk of adverse waitlist removal among ethnic/racial groups.

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

American Journal of Transplantation ◽

10.1111/j.1600-6143.2006.01411.x ◽

2006 ◽

Vol 6 (8) ◽

pp. 1957-1962 ◽

Cited By ~ 39

Author(s):

P. Sharma ◽

A. M. Harper ◽

J. L. Hernandez ◽

T. Heffron ◽

D. C. Mulligan ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Meld Score

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Liver Transplantation for Extended Criteria Hepatocellular Carcinoma Using Stable Response to Locoregional Therapy and Alpha-Fetoprotein as Selection Criteria

Visceral Medicine ◽

10.1159/000506752 ◽

2020 ◽

Vol 36 (6) ◽

pp. 506-515

Author(s):

Markus Bo Schoenberg ◽

Hubertus Johann Wolfgang Anger ◽

Julian Nikolaus Bucher ◽

Gerald Denk ◽

Enrico Narciso De Toni ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Selection Criteria ◽

Validation Cohort ◽

Alpha Fetoprotein ◽

Long Term Results ◽

Locoregional Therapy ◽

Internal Validation ◽

Dynamic Selection ◽

Transplant Candidates

Introduction: Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (INMC) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUTMC) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology. Methods: OUTMC patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUTMC patients required (INMUC): (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with INMC tumors served as control and internal validation cohort. Results: 31 of 170 liver transplant candidates were OUTMC. Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted INMC compared to those OUTMC INMUC (92.2% vs. 70.8%; p = 0.026) after 5 years of follow-up. Overall survival showed no significant difference (p = 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the INMC patients as internal validation cohort (c-index: 0.896; CI 0.588–0.981, p = 0.005). Conclusion: Dynamic selection criteria for the stratification of patients with OUTMC HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to INMC patients.

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What is the role of adjuvant therapy after liver transplantation for hepatocellular carcinoma?

Liver Transplantation ◽

10.1002/lt.22367 ◽

2011 ◽

Vol 17 (S2) ◽

pp. S147-S158 ◽

Cited By ~ 8

Author(s):

Christophe Duvoux ◽

Tetsuya Kiuchi ◽

Bernhard Pestalozzi ◽

Ronald Busuttil ◽

Rebecca Miksad

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Adjuvant Therapy

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

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.346 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 346-346 ◽

Cited By ~ 1

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]

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Perioperative calculator to predict complications for patients with hepatocellular carcinoma resection.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.446 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 446-446

Author(s):

Katherine Ostapoff ◽

Kristopher Attwood ◽

Sergei Kurenov ◽

Boris W. Kuvshinoff ◽

Steven N. Hochwald ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Platelet Count ◽

Surgical Procedure ◽

Prediction Models ◽

Validation Cohort ◽

Meld Score ◽

Curative Intent ◽

Morbidity Score ◽

Morbidity Data ◽

Acs Nsqip Database

446 Background: Hepatocellular carcinoma (HCC) is a common cancer worldwide, but few patients are optimal surgical candidates due to liver disease. Current prediction models (Childs-Pugh and MELD) poorly estimate serious morbidity risks for those patients considering resection. Methods: Using ACS-NSQIP database, patients with HCC were selected from 2006-2013. Patients included had a curative resection (partial hepatectomy or formal lobectomy) and were excluded if they had emergency surgery or disseminated cancer. Outcomes included 30 day morbidity and serious morbidity. Data was randomly divided into testing (n=1764) and validation (n=441) cohorts. Regression analyses of the testing cohorts were used to construct prediction models, then optimized using the validation cohort. Results: We identified 2,205 patients. Major morbidity or serious morbidity occurred in 34% (n=745) and 21% (n=456). Patient demographics are shown in Table 1. Factors significant for morbidity include age, surgical procedure, BMI, ASA class, hypertension, alkaline phosphatase (AP), bilirubin (Bili), BUN, AST, albumin and MELD score. Factors included in risk score for morbidity included MELD, ASA class, surgical procedure, platelet count, smoking and AP. The model predicts morbidity AUC 0.616 vs 0.597 for model and validation cohort respectively. Factors significant for serious morbidity included age, race, procedure, BMI, diabetes, ASA class, hypertension, AP, Bili, AST and albumin. Serious morbidity score included MELD, surgical procedure, platelet count, diabetes and AST. The model predicts serious morbidity AUC 0.566 vs 0.592 for model and validation cohort respectively. Conclusions: Our calculator predicts morbidity based on surgical procedure for patients undergoing HCC curative intent surgery. Risk prediction can assist in appropriately selecting patients for surgical vs medial therapy. [Table: see text]

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Predictive model for microvascular invasion of hepatocellular carcinoma among candidates for either hepatectomy or liver transplantation.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.4079 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 4079-4079

Author(s):

Hidetoshi Nitta ◽

Marc Antoine Allard ◽

Mylene Sebagh ◽

Gabriella Pittau ◽

Oriana Ciacio ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Predictive Model ◽

Validation Cohort ◽

Microvascular Invasion ◽

Roc Curve Analysis ◽

Training Cohort ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

4079 Background: Microvascular invasion (MVI) is the strongest prognostic factor following surgery of hepatocellular carcinoma (HCC). However, it is usually not available on the preoperative setting. A predictive model of MVI in patients scheduled for hepatic resection (HR) or liver transplantation (LT) would thus help guiding treatment strategy. The aim of this study was to develop a predictive model for MVI of HCC before either HR or LT. Methods: HCC patients who consecutively performed HR or LT from January 1994 to June 2016 at a single institution were subdivided into a training and validation cohort. Risk factors for MVI in the training cohort were used to develop a predictive model for MVI, to be validated in the validation cohort. The outcomes of the HR and LT patients with high or low MVI probability based on the model, were compared using propensity score matching (PSM). Cut-off values for continuous factors were determined based on ROC curve analysis. Results: A total of 910 patients (425 HR, 485 LT) were included in the training (n = 637) and validation (n = 273) cohorts. In the training cohort, multivariate analysis demonstrated that alpha-fetoprotein ≥100ng/ml ( p < 0.0001), largest tumor size ≥40mm ( p = 0.0002), non-boundary HCC type on contrast-enhanced CT ( p = 0.001), neutrophils-to-lymphocytes ratio ≥3.2 ( p = 0.002), aspartate aminotransferase ≥62U/l ( p = 0.02) were independently associated with MVI. Combinations of these 5 factors varied the MVI probability from 15.5% to 91.1%. This predictive model achieved a good c-index of 0.76 in the validation cohort. In PSM (109 HR, 109 LT), there was no difference in survival between HR and LT patients among the high MVI probability (≥50%) patients, (5y-OS; 46.3% vs 42.2%, p = 0.77, 5y-RFS; 54.0% vs 28.8%, p = 0.21). Among the low probability ( < 50%), survival was significantly decreased following HR compared with LT (5y-OS; 54.1% vs 78.8%, p = 0.007, 5y-RFS; 17.3% vs 86.1%, p< 0.0001). Conclusions: This model developed from preoperative data allows reliable prediction of MVI, and may thus help with preoperative decisions about the suitability of HR or LT in patients with HCC.

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