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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
SIMAP500: A novel risk score to identify recipients at higher risk of hepatocellular carcinoma recurrence following liver transplantation
Amr Alnagar, Nekisa Zakeri, Konstantinos Koilias, Rosemary E Faulkes, Rachel Brown, Owen Cain, M Thamara P R Perera, Keith J Roberts, Rebeca Sanabria-Mateos, David C Bartlett, Yuk Ting Ma, Shivan Sivakumar, Shishir Shetty, Tahir Shah, Bobby V M Dasari
Amr Alnagar, Konstantinos Koilias, M Thamara P R Perera, Keith J Roberts, Rebeca Sanabria-Mateos, David C Bartlett, Bobby V M Dasari, Department of HBP and Liver Transplantation Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2GW, United Kingdom
Nekisa Zakeri, Shishir Shetty, Centre for Liver Research, Institute of Biomedical Research, Birmingham B15 2TT, United Kingdom
Rosemary E Faulkes, Tahir Shah, Department of Hepatology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2GW, United Kingdom
Rachel Brown, Owen Cain, Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
Yuk Ting Ma, Shivan Sivakumar, Department of Oncology, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham B15 2GW, United Kingdom
Author contributions: Alnagar A and Dasari BVM created the study concept and design; Alnagar A and Koilias K collected the data; Alnagar A, Faulkes RE, Brown R, Cain O, Perera MTPR, Roberts KJ, Sanabria-Mateos R, Zakeri N and Bartlett DC analysed the data; Alnagar A, Dasari BVM, Perera MTPR, Roberts KJ, Sanabria-Mateos R and Bartlett DC wrote and drafted the manuscript; Ma YT, Sivakumar S, Shetty S, Shah T, Dasari BVM did the final critical revision.
Institutional review board statement: The study has been approved and registered on the clinical audit registration and management system of the trust under the code CARMS-18313.
Informed consent statement: Participants' consent was not obtained but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bobby V M Dasari, FRCS, Surgeon, Department of HBP and Liver Transplantation Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom. b.dasari@bham.ac.uk
Received: April 20, 2024
Revised: May 28, 2024
Accepted: July 1, 2024
Published online: September 18, 2024
Processing time: 101 Days and 12.5 Hours
BACKGROUND
Recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT) has a devastating influence on recipients’ survival; however, the risk of recurrence is not routinely stratified. Risk stratification is vital with a long LT waiting time, as that could influence the recurrence despite strict listing criteria.
AIM
This study aims to identify predictors of recurrence and develop a novel risk prediction score to forecast HCC recurrence following LT.
METHODS
A retrospective review of LT for HCC recipients at University Hospitals Birmingham between July 2011 and February 2020. Univariate and multivariate analyses were performed to identify recurrence predictors, based on which the novel SIMAP500 (satellite nodules, increase in size, microvascular invasion, AFP > 500, poor differentiation) risk score was proposed.
RESULTS
234 LTs for HCC were performed with a median follow-up of 5.3 years. Recurrence developed in 25 patients (10.7%). On univariate analyses, RETREAT score > 3, α-fetoprotein (AFP) at listing 100-500 and > 500, bridging, increased tumour size between imaging at the listing time and explant histology, increase in the size of viable tumour between listing and explant, presence of satellite nodules, micro- and macrovascular invasion on explant and poor differentiation of tumours were significantly associated with recurrence, based on which, the SIMAP500 risk score is proposed. The SIMAP500 demonstrated an excellent predictive ability (c-index = 0.803) and outperformed the RETREAT score (c-index = 0.73). SIMAP500 is indicative of the time to disease recurrence.
CONCLUSION
SIMAP500 risk score identifies the LT recipients at risk of HCC recurrence. Risk stratification allows patient-centric post-transplant surveillance programs. Further validation of the score is recommended.
Core Tip: Hepatocellular carcinoma recurrence following liver transplantation has a devastating effect on recipients’ survival. Different scoring systems were proposed to identify recipients at higher risk of recurrence. We used univariate and multivariate analysis to build a new scoring system [SIMAP500 (satellite nodules, increase in size, microvascular invasion, AFP > 500, poor differentiation)] and validated the novel scoring system using our cohort of liver transplant recipients. SIMAP500 has an excellent predictive power of recurrence and can be used to tailor post-transplant surveillance programs.
