Evidence-Based Medicine
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2014; 20(31): 10900-10907
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10900
Criteria-specific long-term survival prediction model for hepatocellular carcinoma patients after liver transplantation
Fei Teng, Gui-Hua Wang, Yi-Feng Tao, Wen-Yuan Guo, Zheng-Xin Wang, Guo-Shan Ding, Xiao-Min Shi, Zhi-Ren Fu
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
Author contributions: Teng F and Wang GH contributed equally to this work; Teng F designed the study and wrote the paper, while Wang GH collected and analyzed the data; all authors contributed to the manuscript.
Supported by the Foundation of Shanghai Science and Technology Commission NO. 134119a7300 and Shanghai Changzheng Hospital Foundation for Young Scientists NO. 2012CZQN08 and NO. 2012CZQN01
Correspondence to: Zhi-Ren Fu, MD, Organ Transplantation Institute of Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China. zhirenf@vip.sina.com
Telephone: +86-21-81885741 Fax: +86-21-63276788
Received: December 27, 2013
Revised: February 15, 2014
Accepted: May 12, 2014
Published online: August 21, 2014
Processing time: 235 Days and 1.3 Hours
Abstract

AIM: 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).

CONCLUSION: MHCAT can effectively predict long-term survival for HCC patients, but needs to be verified by multi-center retrospective or randomized controlled trials.

Keywords: Criteria; Hepatocellular carcinoma; Liver transplantation; MHCAT; Survival model

Core tip: This study was conducted to establish a model to predict long-term survival of hepatocellular carcinoma (HCC) patients after liver transplantation (MHCAT) with reference to different criteria and peri-transplant risk factors. We found that MHCAT can effectively predict long-term survival for HCC patients, but needs to be verified by multi-center retrospective or randomized controlled trials.