Tailored Prediction Model of Survival after Liver Transplantation for Hepatocellular Carcinoma

Abstract

This study aimed to create a tailored prediction model of hepatocellular carcinoma (HCC)-specific survival after transplantation based on pre-transplant parameters. Data collected from June 2006 to July 2018 were used as a derivation dataset and analyzed to create an HCC-specific survival prediction model by combining significant risk factors. Separate data were collected from January 2014 to June 2018 for validation. The prediction model was validated internally and externally. The data were divided into three groups based on risk scores derived from the hazard ratio. A combination of patient demographic, laboratory, radiological data, and tumor-specific characteristics that showed a good prediction of HCC-specific death at a specific time (t) were chosen. Internal and external validations with Uno’s C-index were 0.79 and 0.75 (95% confidence interval (CI) 0.65–0.86), respectively. The predicted survival after liver transplantation for HCC (SALT) at a time “t” was calculated using the formula: [1 − (HCC-specific death(t’))] × 100. The 5-year HCC-specific death and recurrence rates in the low-risk group were 2% and 5%; the intermediate-risk group was 12% and 14%, and in the high-risk group were 71% and 82%. Our HCC-specific survival predictor named “SALT calculator” could provide accurate information about expected survival tailored for patients undergoing transplantation for HCC.

Posttransplant sequential adrenal and spine metastasis of hepatocellular carcinoma responsive to combined regorafenib and radiotherapy: a case report

“…Risk factors for HCC-specific mortality include biomarkers such as high AFP or PIVKA-II levels, 18-FDG PET scan positivity, and tumor number and size [ 8 ]. Jamtani et al [ 9 ] reported that the 5-year HCC-specific mortality and recurrence rates in low-risk patients were 2% and 5%, respectively; those in middle-risk patients were 12% and 14%, respectively, and those in high-risk patients were 71% and 82%, respectively. In this particular patient, although the pretransplant HCC was within the Milan criteria, the PIVKA-II level was high.…”