Journal of Hepatocellular Carcinoma (Jan 2024)

Prediction of Non-Transplantable Recurrence After Liver Resection for Solitary Hepatocellular Carcinoma

  • Zhang C,
  • Tao Y,
  • Yang R,
  • Wang Y,
  • Yu Y,
  • Zhou Y

Journal volume & issue
Vol. Volume 11
pp. 229 – 240

Abstract

Read online

Chunhui Zhang,1,* Yuqing Tao,1,* Rui Yang,1 Yueqi Wang,1 Yanyan Yu,2 Yang Zhou2 1Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150010, People’s Republic of China; 2Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150010, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yang Zhou, Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, Heilongjiang, 150010, People’s Republic of China, Email [email protected]: Using a combination model of preoperative imaging and clinical factors to predict non-transplantable recurrence (NTR) after liver resection and assist solitary hepatocellular carcinoma (HCC) patients in the selection of early treatment options.Patients and Methods: A retrospective analysis was conducted on 253 solitary HCC patients who underwent radical resection and had preoperative MRI. NTR patients were defined as those exceeding the University of California, San Francisco (UCSF) criteria at the time of recurrence. Cox regression analysis was employed to identify preoperative factors associated with NTR based on clinical and tumor imaging characteristics. A risk scoring model (NTRScore) was developed and validated.Results: Among the 253 patients, 86 (33.9%) experienced recurrence, and among those with recurrence, 34 patients (39.5%) developed NTR. In multivariate analysis, factors associated with NTR included alpha-fetoprotein (AFP) [> 10 ng/mL] [HR: 3.42, 95% confidence interval (CI): 1.54– 7.63, P: 0.003], arterial phase hyperenhancement (APHE) [HR: 2.23, 95% CI: 1.03– 4.81, P: 0.041], washout[HR: 0.35, 95% CI: 0.15– 0.84, P: 0.019], and capsule [HR: 0.44, 95% CI: 0.22– 0.88, P: 0.021]. The β-coefficients of these variables were utilized to develop the weighted NTRScore(c-index 0.72, 95% CI: 0.65– 0.79). The NTR occurrence increased across the three categories (low: 5.6%, medium: 13.6%, high: 35.1%, p < 0.001), and the Kaplan-Meier curves of recurrence-free survival(RFS) and overall survival(OS) show significant differences (p = 0.004 and p< 0.001). Furthermore, the higher NTR categories may be associated with an increased risk of extrahepatic recurrence.Conclusion: The NTRScore demonstrated strong discriminatory ability and may serve as a clinically useful tool to assist in risk stratification and potential to guide treatment and optimal surveillance for patients of solitary hepatocellular carcinoma within UCSF criteria.Keywords: hepatocellular carcinoma, salvage liver transplantation, non-transplantable recurrence, treatment, prognosis

Keywords