Development and validation of a new model for predicting the recurrence of hepatocellular carcinoma after liver transplantation：a single center experience with 325 cases

Abstract

Abstract Background Hepatocellular carcinoma recurrence after liver transplantation has a dismal prognosis. We aimed to develop a new model for effectively predicting the recurrence of hepatocellular carcinoma after liver transplantation. Methods We retrospectively analyzed the clinical data of 325 patients with hepatocellular carcinoma who underwent a first orthotopic liver transplantation at Tianjin First Central Hospital.Univariate and multivariate analyses were used to identify potential predictors. A new scoring model based on the identified predictors was developed and validated. Results Cox multivariate analysis revealed tumor number ≥ 2, ki67 labeling index > 0.23, preoperative neutrophil-lymphocyte ratio > 4, maximum tumor diameter > 5.25 cm, and preoperative serum alpha-fetoprotein > 88.33 ng/ml as independent risk factors for postoperative recurrence in the development cohort. We developed a new scoring model. The patients were divided into high-risk and low-risk groups according to the new scoring model.The 3-year recurrence-free survival rates after liver transplantation in the high-risk group were significantly lower than those in the low-risk group (P < 0.001) and there was a significant difference in the cumulative incidence of recurrence between the two risk groups on competing-risk regression in the two cohorts. Receiver operating characteristic curve analysis showed that the area under the curve was 0.870 in the development cohort and 0.772 in the validation cohort. Hanley–McNeil analysis demonstrated that the new model was superior to the Milan criteria (P = 0.040) for predicting tumor recurrence after liver transplantation. Conclusion The model effectively predicted hepatocellular carcinoma recurrence after liver transplantation, and it is promising as a reference for clinical decision-making.