A Novel Prognostic Nomogram Accurately Predicts Hepatocellular Carcinoma Recurrence after Liver Transplantation: Analysis of 865 Consecutive Liver Transplant Recipients

Agopian, Vatche G.; Harlander-Locke, Michael P.; Zarrinpar, Ali; Kaldas, Fady M.; Farmer, Douglas G.; Yersiz, Hasan; Finn, Richard S.; Tong, Myron J.; Hiatt, Jonathan R.; Busuttil, Ronald W.

doi:10.1016/j.jamcollsurg.2014.12.025

Cited by 218 publications

(208 citation statements)

References 56 publications

(31 reference statements)

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“…To evaluate the predictive accuracy of a nomogram, the C-index is widely used. The bootstrap-corrected C-index for the nomogram formulated in the present study was 0.77, which is comparable or higher than those of past studies, [33][34][35][36][37][38] suggesting the high accuracy of our nomogram for predicting 6-month survival rates. Therefore, in a heterogeneous group of patients with HCC who are referred for RT to LN metastasis, this nomogram can be used effectively to predict survival outcomes.…”

Section: Discussionsupporting

confidence: 81%

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Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Wee

Kim

Chie

et al. 2016

BJR

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Section: Discussionsupporting

confidence: 81%

“…19,27,28,[32][33][34][35][36][37][38] However, in patients undergoing RT for LN metastasis, no prognostic grouping or nomogram has been suggested for use. In our study, a prognostic grouping by the number of risk factors was formulated based on the results of multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Wee

Kim

Chie

et al. 2016

BJR

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“…Microvascular invasion is associated with a high potential for recurrence after resection of HCC. 2,3,16,26 However, the impact of mVI and resection margin in the PR specimen on the outcome of IHR management has not been widely studied.…”

mentioning

confidence: 99%

“…In these studies, the explanted liver in the transplant setting rather than the previously resected HCC was the key factor to predict tumor recurrence. 26,27 Meniconi et al suggested that SLT should not be performed in patients where HCC was observed in the PR with mVI. 28 However, this study did not investigate the impact of mVI in PR on the outcome of SLT.…”

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confidence: 99%

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Ali

Wang

et al. 2016

HPB

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“…No patients in that study who had an elevated NLR survived to 3 years (42). Another large study of patients with LT for HCC noted that as NLR increased each log unit, the risk of HCC recurrence nearly doubled (41). Not only has NLR been demonstrated to be predictive of survival in patients undergoing LT for HCC, it has been successful in evaluating patients undergoing tumor downstaging procedures such as radiofrequency ablation (RFA) (44)(45)(46) and transcatheter arterial chemoembolization (TACE) (47).…”

Section: Neutrophil Lymphocyte Ratio (Nlr)mentioning

confidence: 99%

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Rosenblatt

Tafesh

Halazun

2017

Transl. Gastroenterol. Hepatol.

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Since the advent of the Milan criteria in 1996 and its widespread adoption for selection of patients with hepatocellular carcinoma (HCC) who would benefit from transplant, there has been an extensive hunt for the ideal clinical biomarker to predict HCC recurrence. This is because Milan lack does not include tumor biology indices and recurrence rates remain in the 15-20% range worldwide. While a 'silver-bullet' biomarker has not been found, several useful inflammatory markers have been identified and used in scoring systems that supersede Milan in their ability to predict HCC recurrence post liver transplantation (LT). In this review, we aim to summarize the role of inflammatory markers paly in the selection of HCC patients awaiting LT. measured characteristic to indicate a biological process or response (19). They have the potential to assess the risk of recurrence in HCC without invasive testing, offering yet another tool in a physician's armamentarium to identify the patients who would benefit from LT and those who would not. Currently, several biomarkers are utilized in clinical practice, but both the AASLD and an international consensus (15,20) describe biomarkers as an area of future study. Alpha fetoprotein (AFP) (21)(22)(23)(24) and proteins induced by vitamin K absence II (PIVKA-II) (25-28) have been extensively studied and validated as predictors of HCC outcomes. However, there are patients who do not produce either biomarker and still have high risk of recurrence (29,30). Therefore, pursuing other biomarkers that assess the role of inflammation in malignancy is another method to identify patients at risk of recurrence. The link between inflammation and cancer was postulated in the year 1863 by Virchow, and inflammation has been linked with several gastrointestinal malignancies (31). In the last decade, there has been increasing interest in the use of inflammatory markers as tools to predict poor outcomes in patients with HCC. This review will focus of such inflammatory markers, the role they play in HCC, and how to potentially use these as selection tools for patients awaiting transplant. Neutrophil lymphocyte ratio (NLR)The NLR is a measure of the proportion of peripheral blood neutrophils to lymphocytes and has an important role in predicting outcomes in several malignancies. An elevated NLR can be a marker of both neutrophilia in response to inflammation or peripheral lymphopenia, both first demonstrated the use of NLR in predicting outcomes for HCC in 150 patients undergoing LT for HCC. Of the 13 patients with elevated NLR, 62% had recurrence and, as a cohort, had significantly worse OS and RFS. Of note, even patients within Milan criteria with an elevated NLR, compared to those with normal NLR, had a significantly worse survival (30% vs. 81%) (36). In the largest study in the MELD era from the United States examining post-LT outcomes for HCC, the MORAL score was evaluated for its ability to predict post-LT RFS. The MORAL score was constructed using Cox-regression analyses for factors imp...

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A Novel Prognostic Nomogram Accurately Predicts Hepatocellular Carcinoma Recurrence after Liver Transplantation: Analysis of 865 Consecutive Liver Transplant Recipients

Abstract: Background: While radiological size criteria(Milan/UCSF) have led to improved outcomes

Cited by 218 publications

References 56 publications

Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

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