title: Criteria-specific long-term survival prediction model for hepatocellular carcinoma patients after liver transplantation.
abstract: OBJECTIVE
  To establish a model to predict long-term survival of hepatocellular carcinoma (HCC) patients after liver transplantation (MHCAT).
  
  
  METHODS
  Two hundred and twenty-three patients with HCC were followed for at least six years to identify independent risk factors for long-term survival after liver transplantation (LT). The criteria for HCC liver transplantation included the Milan, University of California San Francisco, Hangzhou and Shanghai Fudan criteria. The Cox regression model was used to build MHCAT specifying these criteria. A survival analysis was carried out for patients with high or low risk.
  
  
  RESULTS
  The one-, three- and five-year cumulative survival of HCC patients after LT was 78.9%, 53.2% and 46.4%, respectively. Of the HCC patients, the proportion meeting the Hangzhou and Fudan criteria was significantly higher than the proportion meeting the Milan criteria (64.6% vs 39.5%, 52.0% vs 39.5%, P < 0.05). Moreover, the proportion meeting the Hangzhou criteria was also significantly higher than the proportion meeting other criteria (P < 0.01). Pre-operative alfa-fetoprotein level, intraoperative blood loss and retransplantation were common significant predictors of long-term survival in HCC patients with reference to the Milan, University of California San Francisco and Fudan criteria, whereas in MHCAT based on the Hangzhou criteria, total bilirubin, intraoperative blood loss and retransplantation were independent predictors. The c-statistic for MHCAT was 0.773-0.824, with no statistical difference among these four criteria. According to the MHCAT scoring system, patients with low risk showed a higher five-year survival than those with high risk (P < 0.001).
  
  
  CONCLUSIONS
  MHCAT can effectively predict long-term survival for HCC patients, but needs to be verified by multi-center retrospective or randomized controlled trials.
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Teng
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Gui-Hua
authors.initials: GH
authors.lastname: Wang
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Tao
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Guo
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Zheng-Xin
authors.initials: ZX
authors.lastname: Wang
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Guo-Shan
authors.initials: GS
authors.lastname: Ding
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Xiao-Min
authors.initials: XM
authors.lastname: Shi
authors.affiliation: Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Zhi-Ren
authors.initials: ZR
authors.lastname: Fu
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins
keywords: Criteria; Hepatocellular carcinoma; Liver transplantation; MHCAT; Survival model