title: A Novel Prognostic Index in Patients With Hepatocellular Cancer Waiting for Liver Transplantation: Time-Radiological-response-Alpha-fetoprotein-INflammation (TRAIN) Score.
abstract: OBJECTIVE
  A novel and easy prognostic score based on the combination of pre-operatively available variables in patients with hepatocellular cancer (HCC) waiting for liver transplantation (LT) has been developed from a long waiting time (WT) training set and then validated in a short-WT set.
  
  
  BACKGROUND
  The role of radiological response to loco-regional therapies, alpha-fetoprotein modification, inflammatory markers, and length of WT has been recently shown to be important selection criteria for the risk of intention-to-treat (ITT)-death and recurrence.
  
  
  METHODS
  The training set consisted of 179 HCC patients listed for LT during the period January 2000 to December 2012 from the UCL Brussels Transplant Centre; the validation set consisted of 110 patients listed during the period January 2005 to December 2014 from the Ancona Liver Centre.
  
  
  RESULTS
  The proposed Time-Radiological-response-Alpha-fetoprotein-INflammation (TRAIN) score was the best predictor of microvascular invasion. A TRAIN score ≥1.0 excellently stratified both the investigated populations in terms of ITT and recurrence survivals. When compared with Milan criteria, the proposed score allowed obtaining an increase of potentially transplantable patients (+8.9% in training set and 24.6% in validation set) without additive recurrence risks.
  
  
  CONCLUSIONS
  The proposed TRAIN score is an easy selection tool based on variables available before LT. This score enables the selection process to be refined in the 2 different scenarios of long and short WT. In case of longer WT, the score is better at predicting risk of death during the WT; in case of short WT, the score is better at identifying risk of post-LT recurrence.
authors.affiliation: *Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc, Université catholique Louvain, Brussels, Belgium†Department of General Surgery and Organ Transplantation, L'Aquila University, L'Aquila‡Unit of Hepatobiliary surgery and Transplantation, Azienda Ospedaliero-Universitaria "Ospedali Riuniti," Torrette Ancona, Italy§Department of Radiology, Azienda Ospedaliero-Universitaria "Ospedali Riuniti," Torrette Ancona, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Daniele
authors.initials: D
authors.lastname: Nicolini
authors.forename: Milton
authors.initials: M
authors.lastname: Inostroza Nunez
authors.forename: Samuele
authors.initials: S
authors.lastname: Iesari
authors.forename: Pierre
authors.initials: P
authors.lastname: Goffette
authors.forename: Andrea
authors.initials: A
authors.lastname: Agostini
authors.forename: Andrea
authors.initials: A
authors.lastname: Giovagnoni
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014850:Waiting Lists; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins