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Article: Validated model for prediction of recurrent hepatocellular carcinoma after liver transplantation in Asian population
Title | Validated model for prediction of recurrent hepatocellular carcinoma after liver transplantation in Asian population |
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Authors | |
Keywords | Hepatocellular carcinoma Liver transplantation Post-transplant recurrence Predictive model |
Issue Date | 2019 |
Publisher | Baishideng Publishing Group Co., Limited. The Journal's web site is located at http://www.wjgnet.com/1948-5204/e-journal.htm |
Citation | World Journal of Gastrointestinal Oncology, 2019, v. 11 n. 4, p. 322-334 How to Cite? |
Abstract | BACKGROUND:
Liver transplantation (LT) is regarded as the best treatment for both primary and recurrent hepatocellular carcinoma (HCC). Post-transplant HCC recurrence rate is relatively low but significant, ranging from 10%-30% according to different series. When recurrence happens, it is usually extrahepatic and associated with poor prognosis. A predictive model that allows patient stratification according to recurrence risk can help to individualize post-transplant surveillance protocol and guidance of the use of anti-tumor immunosuppressive agents.
AIM:
To develop a scoring system to predict HCC recurrence after LT in an Asian population.
METHODS:
Consecutive patients having LT for HCC from 1995 to 2016 at our hospital were recruited. They were randomized into the training set and the validation set in a 60:40 ratio. Multivariable Cox regression model was used to identity factors associated with HCC recurrence. A risk score was assigned to each factor according to the odds ratio. Accuracy of the score was assessed by the area under the receiver operating characteristic curve.
RESULTS:
In total, 330 patients were eligible for analysis (183 in training and 147 in validation). Recurrent HCC developed in 14.2% of them. The median follow-up duration was 65.6 mo. The 5-year disease-free and overall survival rates were 78% and 80%, respectively. On multivariate analysis, alpha-fetoprotein > 400 ng/mL [P = 0.012, hazard ratio (HR) 2.92], sum of maximum tumor size and number (P = 0.013, HR 1.15), and salvage LT (P = 0.033, HR 2.08) were found to be independent factors for disease-free survival. A risk score was calculated for each patient with good discriminatory power (c-stat 0.748 and 0.85, respectively, in the training and validation sets). With the derived scores, patients were classified into low- (0–9), moderate- (> 9–14), and high-risk groups (> 14), and the risk of HCC recurrence in the training and validation sets was 10%, 20%, 54% (c-stat 0.67) and 4%, 22%, 62% (c-stat 0.811), accordingly. The risk stratification model was validated with chi-squared goodness-of-fit test (P = 0.425).
CONCLUSION;
A validated predictive model featuring alpha-fetoprotein, salvage LT, and the sum of largest tumor diameter and total number of tumor nodule provides simple and reliable guidance for individualizing postoperative surveillance strategy. |
Persistent Identifier | http://hdl.handle.net/10722/271247 |
ISSN | 2023 Impact Factor: 2.5 2023 SCImago Journal Rankings: 0.749 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Ma, KW | - |
dc.contributor.author | She, WH | - |
dc.contributor.author | Chan, ACY | - |
dc.contributor.author | Cheung, TT | - |
dc.contributor.author | Fung, JYY | - |
dc.contributor.author | Dai, WC | - |
dc.contributor.author | Lo, CM | - |
dc.contributor.author | Chok, KSH | - |
dc.date.accessioned | 2019-06-24T01:06:11Z | - |
dc.date.available | 2019-06-24T01:06:11Z | - |
dc.date.issued | 2019 | - |
dc.identifier.citation | World Journal of Gastrointestinal Oncology, 2019, v. 11 n. 4, p. 322-334 | - |
dc.identifier.issn | 1948-5204 | - |
dc.identifier.uri | http://hdl.handle.net/10722/271247 | - |
dc.description.abstract | BACKGROUND: Liver transplantation (LT) is regarded as the best treatment for both primary and recurrent hepatocellular carcinoma (HCC). Post-transplant HCC recurrence rate is relatively low but significant, ranging from 10%-30% according to different series. When recurrence happens, it is usually extrahepatic and associated with poor prognosis. A predictive model that allows patient stratification according to recurrence risk can help to individualize post-transplant surveillance protocol and guidance of the use of anti-tumor immunosuppressive agents. AIM: To develop a scoring system to predict HCC recurrence after LT in an Asian population. METHODS: Consecutive patients having LT for HCC from 1995 to 2016 at our hospital were recruited. They were randomized into the training set and the validation set in a 60:40 ratio. Multivariable Cox regression model was used to identity factors associated with HCC recurrence. A risk score was assigned to each factor according to the odds ratio. Accuracy of the score was assessed by the area under the receiver operating characteristic curve. RESULTS: In total, 330 patients were eligible for analysis (183 in training and 147 in validation). Recurrent HCC developed in 14.2% of them. The median follow-up duration was 65.6 mo. The 5-year disease-free and overall survival rates were 78% and 80%, respectively. On multivariate analysis, alpha-fetoprotein > 400 ng/mL [P = 0.012, hazard ratio (HR) 2.92], sum of maximum tumor size and number (P = 0.013, HR 1.15), and salvage LT (P = 0.033, HR 2.08) were found to be independent factors for disease-free survival. A risk score was calculated for each patient with good discriminatory power (c-stat 0.748 and 0.85, respectively, in the training and validation sets). With the derived scores, patients were classified into low- (0–9), moderate- (> 9–14), and high-risk groups (> 14), and the risk of HCC recurrence in the training and validation sets was 10%, 20%, 54% (c-stat 0.67) and 4%, 22%, 62% (c-stat 0.811), accordingly. The risk stratification model was validated with chi-squared goodness-of-fit test (P = 0.425). CONCLUSION; A validated predictive model featuring alpha-fetoprotein, salvage LT, and the sum of largest tumor diameter and total number of tumor nodule provides simple and reliable guidance for individualizing postoperative surveillance strategy. | - |
dc.language | eng | - |
dc.publisher | Baishideng Publishing Group Co., Limited. The Journal's web site is located at http://www.wjgnet.com/1948-5204/e-journal.htm | - |
dc.relation.ispartof | World Journal of Gastrointestinal Oncology | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Hepatocellular carcinoma | - |
dc.subject | Liver transplantation | - |
dc.subject | Post-transplant recurrence | - |
dc.subject | Predictive model | - |
dc.title | Validated model for prediction of recurrent hepatocellular carcinoma after liver transplantation in Asian population | - |
dc.type | Article | - |
dc.identifier.email | She, WH: brianshe@hku.hk | - |
dc.identifier.email | Chan, ACY: acchan@hku.hk | - |
dc.identifier.email | Cheung, TT: cheung68@hku.hk | - |
dc.identifier.email | Fung, JYY: jfung@hkucc.hku.hk | - |
dc.identifier.email | Dai, WC: daiwc@hku.hk | - |
dc.identifier.email | Lo, CM: chungmlo@hkucc.hku.hk | - |
dc.identifier.email | Chok, KSH: chok6275@hku.hk | - |
dc.identifier.authority | Chan, ACY=rp00310 | - |
dc.identifier.authority | Cheung, TT=rp02129 | - |
dc.identifier.authority | Fung, JYY=rp00518 | - |
dc.identifier.authority | Lo, CM=rp00412 | - |
dc.identifier.authority | Chok, KSH=rp02110 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.4251/wjgo.v11.i4.322 | - |
dc.identifier.pmid | 31040897 | - |
dc.identifier.pmcid | PMC6475674 | - |
dc.identifier.scopus | eid_2-s2.0-85065627094 | - |
dc.identifier.hkuros | 297964 | - |
dc.identifier.volume | 11 | - |
dc.identifier.issue | 4 | - |
dc.identifier.spage | 322 | - |
dc.identifier.epage | 334 | - |
dc.identifier.isi | WOS:000465126900005 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 1948-5204 | - |