Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2019; 11(4): 322-334
Published online Apr 15, 2019. doi: 10.4251/wjgo.v11.i4.322
Validated model for prediction of recurrent hepatocellular carcinoma after liver transplantation in Asian population
Ka Wing Ma, Wong Hoi She, Albert Chi Yan Chan, Tan To Cheung, James Yan Yue Fung, Wing Chiu Dai, Chung Mau Lo, Kenneth Siu Ho Chok
Ka Wing Ma, Wong Hoi She, Wing Chiu Dai, Department of Surgery, the University of Hong Kong, Hong Kong, China
Albert Chi Yan Chan, Tan To Cheung, Chung Mau Lo, Kenneth Siu Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
James Yan Yue Fung, Department of Medicine and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: Ma KW was responsible for study design, data collection and analysis, manuscript writing, and proofreading; She WH, Chan ACY, Cheung TT, Fung JYY, Dai WC, and Lo CM were responsible for data collection and proofreading; Chok KSH was responsible for supervising the study, data collection, and proofreading.
Institutional review board statement: Institutional review board approval was not required for retrospective observational study.
Informed consent statement: Informed consent to the use of patient data for research purpose was obtained from all patients before transplantation.
Conflict-of-interest statement: None of the authors has any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kenneth Siu Ho Chok, FRCS (Ed), Associate Professor, Department of Surgery, the University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. chok6275@hku.hk
Telephone: +852-22553025
Received: November 19, 2018
Peer-review started: November 19, 2018
First decision: December 7, 2018
Revised: January 3, 2019
Accepted: January 8, 2019
Article in press: January 9, 2019
Published online: April 15, 2019
ARTICLE HIGHLIGHTS
Research background

Disease recurrence remains the chief reason for post-transplant mortality for hepatocellular carcinoma (HCC) patients. High risk patients should undergo close biochemical and radiological surveillance and start immunosuppressive agent with anti-tumor effect soon after the operation. A risk predictive model helps to implement this strategy selectively; however, the availability of such model is limited in the literature.

Research motivation

A more well-known validated model, the RETREAT score, had been popularized in Western Europe and North America. However, this model had not been validated in Asian populations where the prevalence of hepatitis B virus (HBV) infection is high. Therefore, another validated model that serves a complementary role to the RETREAT score has value.

Research objectives

This study aimed to derive and validate a predictive model using a database from a large transplant center.

Research methods

All patients were randomly allocated to training and validation sets. Factors that predict HCC recurrence were identified using multivariate analysis. A risk score was assigned to each of these factors according to their corresponding odds ratio and then a scoring model was developed. The accuracy of this model was validated and compared with other scoring models using data in the validation set with receiver-operating characteristic curve.

Research results

This is the first scoring model derived and validated in an Asian population. It is also the first time to incorporate salvage liver transplantation (LT) as one of the variables in the predictive system. This new model compared favorably with the RETREAT score, which did not include salvage LT in the multivariate analysis.

Research conclusions

We believe that salvage LT should be included in the predictive model for post-LT HCC recurrence. This new model could be an improvement for Asian populations where HBV infection is prevalent.

Research perspectives

Patients who were classified as high risk of HCC recurrence should be given close biochemical and radiological surveillance to detect early recurrence. In addition, immunosuppressant with anti-tumor effect (i.e., m-TOR inhibitor) should be commenced after 1 mo together with the minimization of calcineurin inhibitor. Future multi-center external validation should be contemplated to define further its accuracy and role.