Preoperative risk stratification for early recurrence of HBV-related hepatocellular carcinoma after deceased donor liver transplantation: a five-eight model development and validation

Abdulahad Abdulrab Mohammed Al-Ameri,Shusen Zheng,Xuyong Wei,Lin Zhou,Zhou Shao,Lidan Lin,Xiao Xu,Haiyang Xie,Haijun Guo

doi:10.1186/s12885-019-6343-4

Abdulahad Abdulrab Mohammed Al-Ameri, Shusen Zheng + Show 7 more

Open Access

https://doi.org/10.1186/s12885-019-6343-4

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Abstract

BackgroundEarly recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is associated with poor surgical outcomes. This study aims to construct a preoperative model to predict individual risk of post-LT HCC recurrence.MethodsData of 748 adult patients who underwent deceased donor LT for HCC between January 2015, and February 2019 were collected retrospectively from the China Liver Transplant Registry database and randomly divided into training (n = 486) and validation(n = 262) cohorts. A multivariate analysis was performed and the five-eight model was developed.ResultsA total of 748 patients were included in the study; of them, 96% had hepatitis B virus (HBV) and 84% had cirrhosis. Pre-LT serum alpha-fetoprotein (AFP), tumor number and largest tumor diameter were incorporated to construct the 5–8 model which can stratify patients accurately according to their risk of recurrence into three prognostic subgroups; low-(0–5 points), medium-(6–8 points) and high-risk (> 8 points) with 2-year post-LT recurrence rate of (5,20 and 51%,p < 0.001) respectively. The 5–8 model was better than Milan, Hangzhou, and AFP-model for prediction of HCC early recurrence. These findings were confirmed by the results of the validation cohort.ConclusionsThe 5–8 model is a simple validated and accurate tool for preoperative stratification of early recurrence of HCC after LT.

Highlights

Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is associated with poor surgical outcomes
Inclusion criteria were [1] adult patients with age ≥ 18 [2] preoperative radiologically diagnosed HCC depending on guidelines of the current guidelines of American Association for the Study of Liver Diseases (AASLD) [14] [3] no history of previous LT or combined hepatorenal transplantation [4] patients who survived at least 3 months after the date of surgery [5] no incidental HCC [6] all the clinical and laboratory data required for the analysis are available
A total of 748 patients were included in the study with a mean age of 51.6 ± 8.6 and 89.6% were male

Summary

Introduction

Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is associated with poor surgical outcomes. This study aims to construct a preoperative model to predict individual risk of post-LT HCC recurrence. Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the third leading cause of cancer-related deaths [1]. Alpha-fetoprotein (AFP) is a potential biomarker for early diagnosis and prediction of HCC recurrence. In addition to AFP, there are well recognized preoperative risk factors which reflect the biological behavior of HCC and closely associated with post-LT HCC recurrence including vitamin K absence-II and neutrophil-to-lymphocyte ratio [9, 10]. The predominant morphological factors that show correlation with higher rates of HCC recurrence after LT include; tumor number and size [11, 12]

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