Abstract
// Junyi Shen 1, * , Chuan Li 1, * , Jun Wen 2 , Tianfu Wen 1 , Lvnan Yan 1 , Bo Li 1 , Jiayin Yang 1 and Highness Tholakkara Nazar 1 1 Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Chengdu, Sichuan Province, China 2 Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu, Sichuan Province, China * These authors contributed equally to this work Correspondence to: Tianfu Wen, email: cdwentianfu@126.com Keywords: nomogram; prognosis; hepatocelluar carcinoma; liver transplantation Received: May 23, 2017 Accepted: January 02, 2018 Published: January 02, 2018 ABSTRACT Background: A model to predict individual prognosis after liver transplantation (LT) has not been clearly established. We aimed to create nomograms for prediction of individual survival after LT for hepatocelluar carcinoma (HCC). Results: There were 128(61.2%) patients within the Milan criteria. Before transplantation, 43 (20.6%) patients received transcatheter arterial chemoembolization (TACE) and 22 (10.5%) received radiofrequency ablation(RFA). Multivariate predictors of survival included tumor size, tumor number and tumor differentiation. Nomograms for OS and recurrence free survival (RFS) have been created. Discrimination and calibration of the nomograms revealed good predictive abilities(C-index, RFS: 0.74; OS: 0.70). Compared with Milan criteria, UCSF criteria, up-to-seven criteria and Hangzhou criteria, the OS nomogram improved accuracy in predicting prognosis after transplantation for HCC, ( p < 0.05 for all). Finally, three subgroups were generated based on the total risk points (A’: 1.88–76.5 points; B’: 76.6–113.9points; C’: 113.9–151.3points). The 5-year survival rate were 86.1% for group A’, 59.1% for group B’, and 28.9% for group C’, respectively. Conclusions: The nomograms had good ability in predicting prognostic survival for HCC patients after LT. Patients with score above 113.9 points had poor survival after LT. Materials and method: Between Juanuary 2002 and September 2015, 209 HCC patients who received liver transplantation in the West China Hospital were collected for this study. Prognostic nomograms predicting post-transplant prognosis were developed from a multivariate cox regression. The prediction power of the nomograms was tested by C-statistic and calibration plots.
Highlights
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death in the AsiaPacific region
China accounts for about 50% of all hepatocelluar carcinoma (HCC) cases worldwide because of high prevalence of hepatitis B viral (HBV) infection [1]
Considering the shortage of liver donor and long-term survival, in 1996, Mazzaferro, et al proposed the widely accepted liver transplantation criteria-the Milan criteria (Single tumor ≤5 cm in size or ≤3 tumors each ≤3 cm in size, and no macrovascular invasion) [2]
Summary
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death in the AsiaPacific region. Liver transplantation (LT) is a rational therapeutic option for HCC patients because it addresses the cancer and treats the underlying liver disease. Considering the shortage of liver donor and long-term survival, in 1996, Mazzaferro, et al proposed the widely accepted liver transplantation criteria-the Milan criteria (Single tumor ≤5 cm in size or ≤3 tumors each ≤3 cm in size, and no macrovascular invasion) [2]. Patients within the Milan criteria could achieve 5-year survival of above 70% [3]. A model to predict individual prognosis after liver transplantation (LT) has not been clearly established. We aimed to create nomograms for prediction of individual survival after LT for hepatocelluar carcinoma (HCC)
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