title: Identifying patients at higher risk of hepatocellular carcinoma recurrence after liver transplantation in a multicenter cohort study from Argentina.
abstract: OBJECTIVE
  The Up-to-7 criteria on the basis of the explanted liver features categorize patients at higher risk of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). The aim of this study was to propose a novel pretransplant scoring system to predict recurrence including pre-LT data.
  
  
  METHODS
  From 763 consecutive adult patients who underwent transplantation in four LT centers from Argentina, 124 patients with HCC were included. A scoring system was developed in 87 patients from pre-LT risk factors for recurrence as determined by hazard ratios (HRs) from a multivariate Cox regression analysis.
  
  
  RESULTS
  Overall survival and recurrence rates at 5 years were 63.3 and 13.7%, respectively, during a follow-up period of 3.5±2.2 years. Variables associated with HCC recurrence on multivariate analysis were α-fetoprotein more than 100 ng/ml (HR=5.6, P=0.001) and tumor beyond Up-to-7 imaging criteria (HR=6.3, P=0.001). Bootstrap validation showed that overfitting was negligible. Scoring points were assigned as follows (0-2 points): pre-LT α-fetoprotein more than 100 ng/ml (presence=1 point, absence=0 point), and tumor beyond Up-to-7 imaging criteria (presence=1 point, absence=0 point). AUROC curve indicated a c-statistic of 0.74 (0.58-0.88, P=0.003). Two distinct subgroups of patients were identified with a cut-off more than or equal to 1 point (62% sensitivity and 82% specificity): low risk (0 point) and high risk (1-2 points). The 5-year recurrence rate was 9.4 and 44.5% (P=0.0001) and the 5-year overall survival was 78.1 and 34.8% (P=0.0001) in the low-risk and high-risk groups, respectively.
  
  
  CONCLUSIONS
  This scoring model may be a useful additional tool for HCC recurrence risk stratification before LT. Prospective studies are needed to evaluate our model.
authors.affiliation: aHepatology and Liver Transplant Unit, Hospital Universitario Austral bLiver Transplant Unit, Hospital Italiano de Buenos Aires cLiver Transplant Unit, Hospital Alemán, Buenos Aires dSchool of Medicine, University of Buenos Aires, Buenos Aires eLiver Transplant Unit, Hospital Allende, Córdoba, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Piñero
authors.forename: Sebastián
authors.initials: S
authors.lastname: Marciano
authors.forename: Margarita
authors.initials: M
authors.lastname: Anders
authors.forename: Federico
authors.initials: F
authors.lastname: Orozco Ganem
authors.forename: Alina
authors.initials: A
authors.lastname: Zerega
authors.forename: Joaquin
authors.initials: J
authors.lastname: Cagliani
authors.forename: Oscar
authors.initials: O
authors.lastname: Andriani
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.forename: Octavio
authors.initials: O
authors.lastname: Gil
authors.forename: Luis G
authors.initials: LG
authors.lastname: Podestá
authors.forename: Lucas
authors.initials: L
authors.lastname: McCormack
authors.forename: Adrián
authors.initials: A
authors.lastname: Gadano
authors.forename: Marcelo
authors.initials: M
authors.lastname: Silva
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001118:Argentina; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003661:Decision Support Techniques; D018572:Disease-Free Survival; 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; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins