Predicting survival after liver transplantation in patients with hepatocellular carcinoma using the LiTES-HCC score

Goldberg, David S.; Mantero, Alejandro; Newcomb, Craig; Delgado, Cindy; Forde, Kimberly A.; Kaplan, David E.; John, Binu; Nuchovich, Nadine; Dominguez, Barbara; Emanuel, Ezekiel J.; Reese, Peter P.

doi:10.1016/j.jhep.2020.12.021

Cited by 26 publications

(40 citation statements)

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“…Especially, the severity of cirrhosis at risk for the development of de novo HCC is removed ( 52 ). Waitlist priority for a LT in America and Europe follows the “sickest-first” principle: decompensated cirrhosis and HCC ( 53 ). In order to limit LT to those with poor post-LT outcomes, HCC waitlist priority has mainly relied on two criteria: Milan criteria (solitary tumor <5 cm or up to three nodules and each <3 cm in size, without major vascular invasion) and University of California-San Francisco (UCSF, solitary tumor of 6.5 cm, or three nodules with the largest diameter of 4.5 cm and a total tumor diameter of 8 cm) criteria, to exclude those with high risks of tumor recurrence ( 54 , 55 ).…”

Section: And Surgical Outcomesmentioning

confidence: 99%

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

et al. 2021

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Although liver resection (LR) and liver transplantation (LT) are widely considered as potentially curative therapies for selected patients with hepatocellular carcinoma (HCC); however, there is still high risk of tumor recurrence in majority of HCC patients. Previous studies demonstrated that the presence of microvascular invasion (MVI), which was defined as the presence of tumor emboli within the vessels adjacent to HCC, was one of the key factors of early HCC recurrence and poor surgical outcomes after LR or LT. In this review, we evaluated the impact of current MVI status on surgical outcomes after curative therapies and aimed to explore the surgical strategies for HCC based on different MVI status with evidence from pathological examination. Surgical outcomes of HCC patients with MVI have been described as a varied range after curative therapies due to a broad spectrum of current definitions for MVI. Therefore, an international consensus on the validated definition of MVI in HCC is urgently needed to provide a more consistent evaluation and reliable prediction of surgical outcomes for HCC patients after curative treatments. We concluded that MVI should be further sub-classified into MI (microvessel invasion) and MPVI (microscopic portal vein invasion); for HCC patients with MPVI, local R0 resection with a narrow or wide surgical margin will get the same surgical results. However, for HCC patients with MI, local surgical resection with a wide and negative surgical margin will get better surgical outcomes. Nowadays, MVI status can only be reliably confirmed by histopathologic evaluation of surgical specimens, limiting its clinical application. Taken together, preoperative assessment of MVI is of utmost significance for selecting a reasonable surgical modality and greatly improving the surgical outcomes of HCC patients, especially in those with liver cirrhosis.

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Section: And Surgical Outcomesmentioning

confidence: 99%

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

et al. 2021

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“…In particular, whether it is appropriate to transplant T2 HCC patients in these situations of acute organ shortage remains controversial. T2 HCC (single nodule 2-5 cm, or 2-3 nodules ≤ 3 cm) now represents the vast majority of listed HCC patients [23], reaching almost 40% of overall transplant indications in Italy [6,24]. These patients, however, do not have an immediate risk of dying without LT, thus, in situations of acute organ shortage, many countries have limited their resources only to the most urgent patients [8,14].…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation for T2 Hepatocellular Carcinoma during the COVID-19 Pandemic: A Novel Model Balancing Individual Benefit against Healthcare Resources

Cillo

Vitale

Volk

et al. 2021

Cancers

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The COVID-19 pandemic caused temporary drops in the supply of organs for transplantation, leading to renewed debate about whether T2 hepatocellular carcinoma (HCC) patients should receive priority during these times. The aim of this study was to provide a quantitative model to aid decision-making in liver transplantation for T2 HCC. We proposed a novel ethical framework where the individual transplant benefit for a T2 HCC patient should outweigh the harm to others on the waiting list, determining a “net benefit”, to define appropriate organ allocation. This ethical framework was then translated into a quantitative Markov model including Italian averages for waiting list characteristics, donor resources, mortality, and transplant rates obtained from a national prospective database (n = 8567 patients). The net benefit of transplantation in a T2 HCC patient in a usual situation varied from 0 life months with a model for end-stage liver disease (MELD) score of 15, to 34 life months with a MELD score of 40, while it progressively decreased with acute organ shortage during a pandemic (i.e., with a 50% decrease in organs, the net benefit varied from 0 life months with MELD 30, to 12 life months with MELD 40). Our study supports the continuation of transplantation for T2 HCC patients during crises such as COVID-19; however, the focus needs to be on those T2 HCC patients with the highest net survival benefit.

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“…Several prognostic liver transplant-related risk scores for hepatocellular carcinoma (HCC) have been developed in recent years. The most prominent scores, displayed in Table 1, are based exclusively on HCC-related variables (1)(2)(3)(4)(5)(6). Given that non-HCC-related variables can also influence post-transplant outcomes, Goldberg et al sought to develop a continuous risk score predicting post-transplant survival for patients using both HCCand non-HCC-related variables (1).…”

mentioning

confidence: 99%

“…The most prominent scores, displayed in Table 1, are based exclusively on HCC-related variables (1)(2)(3)(4)(5)(6). Given that non-HCC-related variables can also influence post-transplant outcomes, Goldberg et al sought to develop a continuous risk score predicting post-transplant survival for patients using both HCCand non-HCC-related variables (1). Their LiTES-HCC score, recently published in the Journal of Hepatology, was developed by analyzing national registry (OPTN/UNOS) data of 6,502 adult HCC patients that received a deceaseddonor liver transplant.…”

mentioning

confidence: 99%

“…However, in the absence of clear inclusion/exclusion criteria, inferences may be incorrectly extrapolated to larger populations than targeted by the study. For example, the LiTES-HCC score's study included waitlisted HCC patients, but not those with a waiting time of <6 months (1). Though the rationale for exclusion is described, it presents critical information about applicability.…”

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confidence: 99%

See 1 more Smart Citation

Prognostic risk scores for liver transplantation: game changers or statistical artworks?

Claasen¹,

Ivanics²,

Gravely³

2021

Hepatobiliary Surg Nutr

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Predicting survival after liver transplantation in patients with hepatocellular carcinoma using the LiTES-HCC score

Cited by 26 publications

References 50 publications

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

Liver Transplantation for T2 Hepatocellular Carcinoma during the COVID-19 Pandemic: A Novel Model Balancing Individual Benefit against Healthcare Resources

Prognostic risk scores for liver transplantation: game changers or statistical artworks?

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