Preoperative risk stratification for early recurrence of HBV-related hepatocellular carcinoma after deceased donor liver transplantation: a five-eight model development and validation
Abdulahad Abdulrab Mohammed Al-Ameri,
Xuyong Wei,
Lidan Lin,
Zhou Shao,
Haijun Guo,
Haiyang Xie,
Lin Zhou,
Shusen Zheng,
Xiao Xu
Affiliations
Abdulahad Abdulrab Mohammed Al-Ameri
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Xuyong Wei
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Lidan Lin
China Liver Transplant Registry
Zhou Shao
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Haijun Guo
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Haiyang Xie
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Lin Zhou
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Shusen Zheng
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Xiao Xu
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine; Institution of Organ Transplantation, Zhejiang University
Abstract Background Early recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is associated with poor surgical outcomes. This study aims to construct a preoperative model to predict individual risk of post-LT HCC recurrence. Methods Data of 748 adult patients who underwent deceased donor LT for HCC between January 2015, and February 2019 were collected retrospectively from the China Liver Transplant Registry database and randomly divided into training (n = 486) and validation(n = 262) cohorts. A multivariate analysis was performed and the five-eight model was developed. Results A total of 748 patients were included in the study; of them, 96% had hepatitis B virus (HBV) and 84% had cirrhosis. Pre-LT serum alpha-fetoprotein (AFP), tumor number and largest tumor diameter were incorporated to construct the 5–8 model which can stratify patients accurately according to their risk of recurrence into three prognostic subgroups; low-(0–5 points), medium-(6–8 points) and high-risk (> 8 points) with 2-year post-LT recurrence rate of (5,20 and 51%,p < 0.001) respectively. The 5–8 model was better than Milan, Hangzhou, and AFP-model for prediction of HCC early recurrence. These findings were confirmed by the results of the validation cohort. Conclusions The 5–8 model is a simple validated and accurate tool for preoperative stratification of early recurrence of HCC after LT.