title: Prediction of hepatocellular carcinoma recurrence after liver transplantation: Comparison of four explant-based prognostic models.
abstract: Discordance between pre-LT imaging and explanted liver findings have been reported after liver transplantation (LT) for hepatocellular carcinoma (HCC), suggesting the need of reassessing the risk of HCC recurrence post-LT. Our aims were to compare pre-LT imaging and explants features and to test the performances of four explant-based predictive models of recurrence in an external cohort.
  
  
  
  Staging according to pre-LT imaging and explant features were compared. Four explants-based models were retrospectively tested in a cohort of 372 patients transplanted for HCC in 19 French centres between 2003 and 2005. Accuracies of the scores were compared.
  
  
  
  Pre-LT imaging underestimated tumour burden in 83 (22.7%) patients according to Milan criteria. The highest AUCs for prediction of 5-years recurrence were observed in the "Up to seven" (0.7915 [95% CI: 0.7339-0.849]) and Decaens models (0.747 [95% CI: 0.6877-0.806]), with two levels of risk: low (10%) and high (>50%). Chan and Iwatsuki models identified 3 and 4 levels of risk, but had lower AUCs (0.68 and 0.70) respectively. Accuracy of the "Up to seven" model was superior to the Decaens model (P=.034), which was superior to the Chan model (P=.0041) but not to the Iwatsuki model (P=.17).
  
  
  
  Pre-LT imaging underestimates tumour burden, and prediction of recurrence should be reassessed after LT. The explant-based "Up to seven" and Decaens models provided the best accuracy for prediction of 5-year recurrence, identifying only two levels of risk. New models are needed to further refine the prediction of recurrence after LT.
authors.affiliation: Service d'hépatologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: Charlotte E
authors.identifier: 0000-0001-6115-8512
authors.initials: CE
authors.lastname: Costentin
authors.affiliation: Service d'hépatologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Amaddeo
authors.affiliation: Service d'hépatologie, CHU Grenoble Alpes, Grenoble, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Decaens
authors.affiliation: Service de Chirurgie digestive, Hôpital Pontchaillou, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
authors.affiliation: Service de Chirurgie digestive, CHU de Strasbourg, Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.affiliation: Service de Chirurgie digestive, Hôpital Rangueil, Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.affiliation: Service de Chirurgie digestive, CHU de Tours, Chambray-lès-Tours, France.
authors.forename: Ephrem
authors.initials: E
authors.lastname: Salamé
authors.affiliation: Service d'hépatologie, Hôpital Saint André, Bordeaux, France.
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bernard
authors.affiliation: Service hépatologie, Hôpital Beaujon, Clichy, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
authors.affiliation: Service hépatologie, Hôpital Claude Huriez, Lille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.affiliation: Service d'hépatologie, Hôpital Jean Minjoz, Besancon, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Vanlemmens
authors.affiliation: Service d'hépatologie, Hôpital Lyon Croix Rousse, Lyon, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Radenne
authors.affiliation: Service d'hépatologie, Hospices Civiles de Lyon, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
authors.affiliation: Service d'hépatologie, CHU Grenoble Alpes, Grenoble, France.
authors.forename: Marie-Noelle
authors.initials: MN
authors.lastname: Hilleret
authors.affiliation: Service d'hépatologie, Hôpital Saint Antoine, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chazouillères
authors.affiliation: Service d'hépatologie, Hôpital Saint Eloi, Montpellier, France.
authors.forename: Georges P
authors.initials: GP
authors.lastname: Pageaux
authors.affiliation: Département de Pathologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Calderaro
authors.affiliation: Service de Chirurgie digestive, Hôpital Henri Mondor, Créteil, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.affiliation: Service d'hépatologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.affiliation: Service d'hépatologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
mesh_terms: D000328:Adult; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D047368:Tumor Burden
keywords: explant pathology; hepatocellular carcinoma; liver transplantation; recurrence