Development of a survival evaluation model for liver transplant recipients with hepatocellular carcinoma secondary to hepatitis B.
OBJECTIVE
To develop a model using easily obtainable, objective, verifiable preoperative parameters, to help evaluate post transplant survival probability for hepatocellular carcinoma (HCC) patients with hepatitis B.


METHODS
We retrospectively examined a cohort of 150 consecutive primary cadaveric liver transplants with HCC in our center over 6 years. Thirteen preoperative biochemical parameters and six tumor-related factors were analyzed to identify their correlation with post transplant survival using the Cox proportional-hazards regression model. The predictive power of a new model and the model for end stage liver disease was compared by the receiver operating characteristic curve.


RESULTS
In univariate analysis, the factors significantly associated with post transplant survival were serum concentrations of albumin, total bilirubin, alkaline phosphatase, alpha-fetoprotein, gamma-glutamyltransferase, aspartate aminotransferase, sodium, tumor diameter and the number of tumor nodules. Multivariate analysis showed alpha-fetoprotein, serum sodium, alkaline phosphatase and the number of tumor nodules were significantly associated with the post transplant outcome. Based on the four variables, we established a new model with a c-statistic of 0.72 which was significantly greater than 0.50 (P = 0.001), and the c-statistic of MELD was 0.59 (P = 0.146).


CONCLUSIONS
The new model based on four objective tumor-related parameters has the capacity to evaluate the risk of post transplant mortality for HCC patients with hepatitis B.
Zhang
Ming
M
Liver Transplantation Center, West China Hospital, Sichuan University Medical School, Chengdu 610041, Sichuan Province, China.
Li
Bo
B
Yan
Lu-Nan
LN
Yin
Fei
F
Wen
Tian-Fu
TF
Zeng
Yong
Y
Zhao
Ji-Chun
JC
Ma
Yu-Kui
YK
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D002470:Cell Survival; D015331:Cohort Studies; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000628:therapy; D008113:Liver Neoplasms / Q000209:etiology* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies