title: Prediction of long-term survival by using the Glasgow Prognostic Score in patients with hepatocellular carcinoma after liver transplantation.
abstract: OBJECTIVE
  This study aimed to validate the prognostic value of the Glasgow Prognostic Score (GPS) in patients who underwent living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Data were retrospectively collected for HCC patients who underwent LDLT. Univariate and multivariate analyses were performed to identify variables associated with overall and recurrence-free survival. Patients were separated into two groups based on the GPS. The predictive ability of the GPS was compared with other variable scores (modified GPS and hepatic GPS) to identify the most accurate test for this population.
  
  
  RESULTS
  Univariate analysis identified a GPS of 1 or 2 (P = 0.018), multiple tumors (P = 0.032) and HCC beyond the Milan criteria (P = 0.015) as factors significantly associated with poor overall survival. Hepatitis B negative status (P = 0.034), a GPS of 1 or 2 (P = 0.030), α-fetoprotein of 20.0 ng/mL or more (P = 0.042) and HCC beyond the Milan criteria (P = 0.002) were identified as factors significantly associated with poor recurrence-free survival. Multivariate analysis indicated that HCC beyond the Milan criteria and a GPS of 1 or 2 were independent risk factors for long-term outcomes. Among the scoring systems evaluated in this study, the GPS was the best predictive system in our population. Moreover, a new scoring system that combined the GPS and the Milan criteria showed the highest prognostic values.
  
  
  CONCLUSIONS
  Novel prediction scores combining the GPS and the Milan criteria provide a precise, objective, and quick approach for selecting appropriate HCC patients for LDLT.
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.affiliation: Advanced Medical Skill Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Hattori
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kuroda
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tahara
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohira
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ide
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishiyama
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
keywords: Glasgow Prognostic Score; Milan criteria; hepatocellular carcinoma; liver transplantation; systemic inflammation