Abstract
Since the introduction of Milan Criteria, all scoring models describing the prognosis of hepatocellular cancer (HCC) after liver transplantation (LT) have been exclusively based on characteristics available at surgery, therefore neglecting the intention-to-treat principles. This study aimed at developing an intention-to-treat model through a competing-risk analysis. Using data available at first referral, an upper limit of tumor burden for downstaging was identified beyond which successful LT becomes an unrealistic goal. Twelve centers in Europe, United States, and Asia (Brussels, Sapienza Rome, Padua, Columbia University New York, Innsbruck, Medanta-The Medicity Dehli, Hong Kong, Kyoto, Kaohsiung Taiwan, Mainz, Fukuoka, Shulan Hospital Hangzhou) created a Derivation (n = 2318) and a Validation Set (n = 773) of HCC patients listed for LT between January 2000–March 2017. In the Derivation Set, the competing-risk analysis identified two independent covariables predicting post-transplant HCC-related death: combined HCC number and diameter (SHR = 1.15; p < 0.001) and alpha-fetoprotein (AFP) (SHR = 1.80; p < 0.001). WE-DS Model showed good diagnostic performances at internal and external validation. The identified upper limit of tumor burden for downstaging was AFP ≤ 20 ng/mL and up-to-twelve as sum of HCC number and diameter; AFP = 21–200 and up-to-ten; AFP = 201–500 and up-to-seven; AFP = 501–1000 and up-to-five. The WE-DS Model proposed here, based on morphologic and biologic data obtained at first referral in a large international cohort of HCC patients listed for LT, allowed identifying an upper limit of tumor burden for downstaging beyond which successful LT, following downstaging, results in a futile transplantation.
Highlights
For a quarter of a century, morphologic Milan Criteria (MC) have been the cornerstone to select patients with hepatocellular cancer (HCC) for liver transplantation (LT) [1]
The primary objective of the study was to predict in a “weighty manner” the risk of post-LT
HCC-related death in transplant candidates, with the intent to identify an upper limit of DS and to HCC-related death in transplant candidates, with the intent to identify an upper limit of DS and to standardize the LT inscription approach based on a large HCC-LT database including collaborating standardize the LTand inscription approach based on a large database collaborating expert Western
Summary
For a quarter of a century, morphologic Milan Criteria (MC) have been the cornerstone to select patients with hepatocellular cancer (HCC) for liver transplantation (LT) [1]. Therapies emerged as a promising tool to fine-tune the selection process of LT candidates in terms of delisting and post-LT recurrence [11,12,13,14,15,16,17,18]. In this context, the identification of an upper limit of tumor burden for DS, evaluated at first referral, is still a matter of debate. Many centers apply a so-called “all-comers” policy, enrolling potential
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
