title: Competing risks analysis of predictors of delisting owing to tumor progression in liver transplant candidates with hepatocellular carcinoma.
abstract: Orthotopic liver transplantation (OLT) is potentially curative for patients with early stage hepatocellular carcinoma (HCC). However, tumor progression before OLT remains a problem. Ninety-three patients were listed for transplantation with HCC or diagnosed with HCC following listing between March, 1997 and September, 2001. Modified TNM Stage was I/II in 82 patients and III in 11 patients. Seventy-one patients (76%) were transplanted with a median waiting time of 3.4 months, and 22 (24%) patients were delisted owing to tumor progression (14), noncompliance (5), and death from liver failure (3). Using a cox model competing risks approach, higher baseline alpha-fetoprotein (AFP) >or= 100 ng/mL was the only factor independently associated with a higher hazard rate of delisting owing to tumor progression (p = 0.00003), whereas four separate factors were independently associated with a lower hazard rate of transplantation: more recent listing year (1999-2001, p = 0.010), blood type O (p = 0.013), Stage I HCC (p = 0.029), and serum bilirubin < 4 mg/dL (p = 0.032). By logistic regression, AFP >/= 100 ng/mL was the only factor that significantly influenced the probability of delisting owing to tumor progression (p = 0.001). In conclusion, the initial AFP level may be useful along with tumor stage in defining an urgency score for liver transplant candidates with HCC.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Miami School of Medicine, Miami, FL, USA.
authors.forename: Noriyo
authors.initials: N
authors.lastname: Yamashiki
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Gaynor
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.forename: Abhasnee
authors.initials: A
authors.lastname: Sobhonslidsuk
authors.forename: David
authors.initials: D
authors.lastname: Levi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Juan
authors.initials: J
authors.lastname: Madariaga
authors.forename: Jose
authors.initials: J
authors.lastname: Nery
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Schiff
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment