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Prediction of hepatocellular carcinoma recurrence after liver transplantation: Comparison of four explant‐based prognostic models
Author(s) -
Costentin Charlotte E.,
Amaddeo Giuliana,
Decaens Thomas,
Boudjema Karim,
Bachellier Philippe,
Muscari Fabrice,
Salamé Ephrem,
Bernard PierreHenri,
Francoz Claire,
Dharancy Sébastien,
Vanlemmens Claire,
Radenne Sylvie,
Dumortier Jérôme,
Hilleret MarieNoelle,
Chazouillères Olivier,
Pageaux Georges P.,
Calderaro Julien,
Laurent Alexis,
RoudotThoraval Françoise,
Duvoux Christophe
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13388
Subject(s) - hepatocellular carcinoma , medicine , liver transplantation , milan criteria , cohort , explant culture , transplantation , overall survival , retrospective cohort study , oncology , gastroenterology , surgery , biology , in vitro , biochemistry
Aim Discordance between pre‐ LT imaging and explanted liver findings have been reported after liver transplantation ( LT ) for hepatocellular carcinoma ( HCC ), suggesting the need of reassessing the risk of HCC recurrence post‐ LT . Our aims were to compare pre‐ LT imaging and explants features and to test the performances of four explant‐based predictive models of recurrence in an external cohort. Methods Staging according to pre‐ LT imaging and explant features were compared. Four explants‐based models were retrospectively tested in a cohort of 372 patients transplanted for HCC in 19 French centres between 2003 and 2005. Accuracies of the scores were compared. Results Pre‐ LT imaging underestimated tumour burden in 83 (22.7%) patients according to Milan criteria. The highest AUC s for prediction of 5‐years recurrence were observed in the “Up to seven” (0.7915 [95% CI : 0.7339‐0.849]) and Decaens models (0.747 [95% CI : 0.6877‐0.806]), with two levels of risk: low (10%) and high (>50%). Chan and Iwatsuki models identified 3 and 4 levels of risk, but had lower AUC s (0.68 and 0.70) respectively. Accuracy of the “Up to seven” model was superior to the Decaens model ( P =.034), which was superior to the Chan model ( P =.0041) but not to the Iwatsuki model ( P =.17). Conclusion Pre‐ LT imaging underestimates tumour burden, and prediction of recurrence should be reassessed after LT . The explant‐based “Up to seven” and Decaens models provided the best accuracy for prediction of 5‐year recurrence, identifying only two levels of risk. New models are needed to further refine the prediction of recurrence after LT .