Rapid Communication
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 28, 2008; 14(8): 1280-1285
Published online Feb 28, 2008. doi: 10.3748/wjg.14.1280
Development of a survival evaluation model for liver transplant recipients with hepatocellular carcinoma secondary to hepatitis B
Ming Zhang, Bo Li, Lu-Nan Yan, Fei Yin, Tian-Fu Wen, Yong Zeng, Ji-Chun Zhao, Yu-Kui Ma
Ming Zhang, Bo Li, Lu-Nan Yan, Tian-Fu Wen, Yong Zeng, Ji-Chun Zhao, Yu-Kui Ma, Liver Transplantation Center, West China Hospital, Sichuan University Medical School, Chengdu 610041, Sichuan Province, China
Fei Yin, Department of Biostatistics, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang M, Li B and Yin F designed the research; Li B, Yan LN, Wen TF, Zeng Y, Zhao JC and Ma YK performed all of the liver transplantations; Zhang M, Yin F collected all of the data and performed the statistical analysis; and Zhang M wrote the paper.
Correspondence to: Bo Li, PhD, Liver Transplantation Center, West China Hospital, Sichuan University Medical School, Chengdu 610041, Sichuan Province, China. zmhxdoctor@gmail.com
Telephone: +86-28-85422476
Fax: +86-28-85500743
Received: October 11, 2007
Revised: December 11, 2007
Published online: February 28, 2008
Abstract

AIM: To develop a model using easily obtainable, objective, verifiable preoperative parameters, to help evaluate post transplant survival probability for hepatocellular carcinoma (HCC) patients with hepatitis B.

METHODS: We retrospectively examined a cohort of 150 consecutive primary cadaveric liver transplants with HCC in our center over 6 years. Thirteen preoperative biochemical parameters and six tumor-related factors were analyzed to identify their correlation with post transplant survival using the Cox proportional-hazards regression model. The predictive power of a new model and the model for end stage liver disease was compared by the receiver operating characteristic curve.

RESULTS: In univariate analysis, the factors significantly associated with post transplant survival were serum concentrations of albumin, total bilirubin, alkaline phosphatase, alpha-fetoprotein, γ-glutamyltransferase, aspartate aminotransferase, sodium, tumor diameter and the number of tumor nodules. Multivariate analysis showed alpha-fetoprotein, serum sodium, alkaline phosphatase and the number of tumor nodules were significantly associated with the post transplant outcome. Based on the four variables, we established a new model with a c-statistic of 0.72 which was significantly greater than 0.50 (P = 0.001), and the c-statistic of MELD was 0.59 (P = 0.146).

CONCLUSION: The new model based on four objective tumor-related parameters has the capacity to evaluate the risk of post transplant mortality for HCC patients with hepatitis B.

Keywords: Liver neoplasms, Hepatitis B, Liver transplantation, Survival evaluation, Model for End Stage Liver Disease