Outcomes of liver transplantation for hepatocellular carcinoma are determined by cancer-related and non-related events.
Treatments for hepatitis C virus infection have reduced non-cancer events among patients receiving liver transplants, so reducing hepatocellular carcinoma related death might be an actionable end point.
Dr Vincenzo Mazzaferro and colleagues from Italy performed a competing-risk analysis to evaluate factors associated with survival of patients with hepatocellular carcinoma, and developed a prognostic model based on features of hepatocellular carcinoma patients before liver transplantation.
The doctors performed multivariable competing-risk regression analysis to identify factors associated with hepatocellular carcinoma-specific death of patients who underwent liver transplantation.
The training set comprized 1018 patients who underwent liver transplantation for hepatocellular carcinoma from 2000 through 2013 at 3 tertiary centers in Italy.
|The cumulative incidence of death was segregated for hepatitis C virus status|
The validation set comprized 341 consecutive patients who underwent liver transplantation for hepatocellular carcinoma during the same period at the Liver Cancer Institute in Shanghai, China.
The researchers collected pretransplantation data on etiology of liver disease, number and size of tumors, patient level of α-fetoprotein, model for end-stage liver disease score, tumor stage, numbers and types of treatment, response to treatments, tumor grade, microvascular invasion, dates, and causes of death.
Death was defined as hepatocellular carcinoma-specific when related to hepatocellular carcinoma recurrence after transplantation, disseminated extra- and/or intrahepatic tumor relapse and worsened liver function in presence of tumor spread.
The team noted that the cumulative incidence of death was segregated for hepatitis C virus status.
In the competing-risk regression, the sum of tumor number and size, and level of α-fetoprotein were significantly associated with hepatocellular carcinoma-specific death.
The researchers found that 5-year cumulative incidence of non−hepatocellular carcinoma related death was 9% in hepatitis C virus-negative patients, and 18% in hepatitis C virus-positive patients.
For patients with hepatocellular carcinoma to have a 70% chance of hepatocellular carcinoma-specific survival 5 years after transplantation, their level of α-fetoprotein should be <200 ng/mL and the sum of number and size of tumors should not exceed 7.
If the level of α-fetoprotein was 200−400 ng/mL, the sum of the number and size of tumors should be ≤5, and if their level of α-fetoprotein was 400−1000 ng/mL, the sum of the number and size of tumors should be ≤4.
In the validation set, the model identified patients who survived 5 years after liver transplantation with 0.721 accuracy.
The research team developed a model based on level of α-fetoprotein, tumor size, and tumor number, to determine risk of death from hepatocellular carcinoma-related factors after liver transplantation.
Dr Mazzaferro's team concluded, "This model might be used to select end points and refine selection criteria for liver transplantation for patients with hepatocellular carcinoma."
"To predict 5-year survival and risk of hepatocellular carcinoma-related death using an online calculator, please see www.hcc-olt-metroticket.org/."