title: Is recurrence rate of incidental hepatocellular carcinoma after liver transplantation similar to previously known HCC? towards a predictive recurrence score.
abstract: BACKGROUND
  Incidental hepatocellular carcinoma (iHCC) generates uncertainty over risk of recurrence after liver transplantation (LT).
  
  
  OBJECTIVE
  To compare recurrence between iHCC and confirmed HCC diagnosed prior to transplant based on imaging criteria (cHCC).
  
  
  METHODS
  Fifty-four HCC patients were analyzed from a series of 309 consecutive adult transplanted patients. We developed a recurrence predicting score (RPS) applying ORs based on pathologic risk variables.
  
  
  RESULTS
  Incidence of iHCC was 4.8% (n = 15) and overall recurrence 12.9% (cHCC 15.4% and iHCC 7%; P = 0.39). Variables included in the RPS were: microvascular invasion OR 17.8 (1.78-178.97; P = 0.014: 2 points), neural invasion OR 15.5 (1.13-212.17; P = 0.04: 1.5 points), nuclear grade > II OR 9.3 (1.17-74.84; P = 0.035: 1 point), and beyond Up-to 7 criteria OR 13.1 (1.66-103.67; P = 0.015: 1.5 points). Two risk groups were identified: low risk for recurrence (0-1 point) and intermediate-high risk groups (2-6 points). Low risk category remained an independent predictor of recurrence: OR 0.11 (0.01-0.67; P = 0.017); AUROC of 0.75 (0.54-0.96). A tendency towards more patients categorized as low risk group among iHCC patients was observed (69.2%; P = 0.13).
  
  
  CONCLUSIONS
  In this series iHCC was not associated to lower risk of recurrence when compared to cHCC. We propose application of an RPS as a clinical tool for recurrence risk estimation.
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral. Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Piñero
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral. Buenos Aires, Argentina.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendizabal
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Italiano de Buenos Aires. Buenos Aires, Argentina.
authors.forename: Paola
authors.initials: P
authors.lastname: Casciato
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Italiano de Buenos Aires. Buenos Aires, Argentina.
authors.forename: Omar
authors.initials: O
authors.lastname: Galdame
authors.affiliation: Epidemiology and Statistics. Hospital Universitario Austral. Buenos Aires, Argentina.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Quiros
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Italiano de Buenos Aires. Buenos Aires, Argentina.
authors.forename: Juan
authors.initials: J
authors.lastname: Bandi
authors.affiliation: Department of Pathology. Hospital Italiano de Buenos Aires. Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mullen
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral. Buenos Aires, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Andriani
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Italiano de Buenos Aires. Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral. Buenos Aires, Argentina.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Podestá
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Italiano de Buenos Aires. Buenos Aires, Argentina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gadano
authors.affiliation: Hepatology and Liver Transplant Unit. Hospital Universitario Austral. Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Silva
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome