title: Tumour size and differentiation in predicting recurrence of hepatocellular carcinoma after liver transplantation: external validation of a new prognostic score.
abstract: BACKGROUND
  A new prognostic score including tumour differentiation--establishing two groups of patients: group A with >3 points and group B with >4 points--improved the accuracy of the Milan criteria in predicting recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) in a large multicentre study (Decaens 2007).
  
  
  OBJECTIVE
  The aim of this study was to validate the new score in our HCC cohort.
  
  
  METHODS
  The study involved 100 consecutive patients with mean age 55 years (range 31-68 years) (M/F: 88/22) transplanted for known HCC: 60 unifocal and 40 multifocal (2-3 nodules in 32 and >or=4 nodules in 8) at pre-LT imaging. Survival differences were analysed by log-rank test. Patient/tumour variables before LT and tumour differentiation at explant were assessed by univariate/multivariate analysis.
  
  
  RESULTS
  Median follow-up was 29 months (range 1-145 months). HCC recurrence was recorded in 18 patients. Five-year recurrence-free survival rate was 67 +/- 7%. Patient survival at 3 months was 84 +/- 4% and at 5 years was 45 +/- 6%. Both recurrence-free survival and patient survival were not significantly different between groups A and B. Diameter of largest nodule was the sole pre-LT variable independently associated with recurrence [odd ratio (OR) 1.07; 95% confidence interval (CI) 1.01-1.12; P = 0.012]. Recurrence-free survival was significantly better in patients with diameter <30 mm compared with those with larger nodules (P = 0.0229). Number of nodules and tumour differentiation did not influence recurrence. There were three HCC recurrences with largest nodule size <30 mm, seven recurrences between 30-40 mm, and eight recurrences >40 mm.
  
  
  CONCLUSIONS
  Tumour differentiation did not add significantly to prediction of HCC recurrence in our cohort. Conversely, diameter of the largest nodule remained a significant risk for recurrence.
authors.affiliation: Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Marelli
authors.forename: A
authors.initials: A
authors.lastname: Grasso
authors.forename: M
authors.initials: M
authors.lastname: Pleguezuelo
authors.forename: H
authors.initials: H
authors.lastname: Martines
authors.forename: R
authors.initials: R
authors.lastname: Stigliano
authors.forename: A P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: D
authors.initials: D
authors.lastname: Patch
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
authors.forename: D
authors.initials: D
authors.lastname: Sharma
authors.forename: K
authors.initials: K
authors.lastname: Rolles
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D002454:Cell Differentiation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate