Challenges related to clinical decision-making in hepatocellular carcinoma recurrence post-liver transplantation: Is there a hope?

Table 1 List of common pre/post-transplant predicting models and scores used in practice

Criteria name	Characteristics	Biomarkers
Milan criteria	Single tumor > 5 cm or ≤ 3 tumors ≤ 3 cm, with no vascular invasion
UCSF criteria	Single nodule ≤ 6.5 cm or 2-3 nodules ≤ 4.5 cm and total tumor diameter ≤ 8 cm, with no vascular invasion
Seoul criteria	Tumor size (≤ 3, 3.1-5, 5.1-6.5, > 6.5 cm) and number (1, 2-3, 4-5, > 5)	AFP (≤ 20, 20.1-200, 200.1-1000, > 1000 ng/mL)
Up-to-7 criteria	Sum of the largest tumour size and number of lesions < 7
AFP-French model	Tumor size (≤ 3, 3-6, > 6 cm) and tumour number (1-3, ≥ 4)	log10 (AFP) simplified version: AFP level (≤ 100, 100-1000, > 1000 ng/mL)
AFP/TTD criteria	Total tumor diameter ≤ 8 cm	AFP ≤ 400 ng/mL
TTV/AFP model	Total tumor volume < 115 cm3, and no macrovascular invasion or extra-hepatic spread	AFP < 400 ng/mL
Extended Toronto criteria	Any size or number of tumours, and no vascular invasion or extra-hepatic spread; No poorly differentiated grades; No symptoms related to cancer (weight loss >10 kg and/ ECOG ≥ 1 in 3 months)
Pre-MORAL score	Largest tumor size > 3 cm	Maximum AFP > 200 ng/mL, preoperative NLR ≥ 5
Metro ticket 2.0 model	Tumor number and size of the largest tumor	AFP (< 200, 200-400, 400-1000, > 1000 ng/mL)
Metro ticket 2.0 + mRECIST criteria	Tumor number and size of the largest tumor; Radiological response to neoadjuvant therapies (mRECIST criteria)	AFP (< 200, 200-400, 400-1000, > 1000 ng/mL)
Metro ticket 2.0 with LI-RADS criteria	Tumor number and size of the largest tumor (Tumor burden evaluated according to LI-RADS criteria)	log10 (AFP)
RETREAT score	Tumor number and size (explant); Presence of vascular invasion	AFP level at transplant
AFP score	Largest tumor size and number	AFP level
TRAIN score	Response to LRT (mRECIST); NLR ratio waiting time till LT	AFP level
MORAL score	Largest tumor size and number explant tumor pathology (differentiation grade) NLR ratio	AFP level

UCSF: University of California San Francisco; AFP: Alpha-fetoprotein; TTD: Total tumor diameter; TTV: Total tumor volume; ECOG: Eastern cooperative oncology group; MORAL: Model of recurrence after liver transplant; NLR: Neutrophil to lymphocyte ratio; mRECIST: Modified response evaluation criteria in solid tumors; LI-RADS: Liver imaging reporting and data system; RETREAT: Risk estimation of tumor recurrence after transplant; TRAIN: Time–radiological-response–alpha-fetoprotein–inflammation.