Development and validation of a REcurrent Liver cAncer Prediction ScorE (RELAPSE) following liver transplantation in patients with hepatocellular carcinoma: Analysis of the US Multicenter HCC Transplant Consortium.

Autor:	Tran BV; Department of Surgery, David Geffen School of Medicine at UCLA, Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Centers, Los Angeles, California, USA., Moris D; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA., Markovic D; Department of Medicine, Statistics Core, University of California, Los Angeles, USA., Zaribafzadeh H; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA., Henao R; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA., Lai Q; General Surgery and Organ Transplantation Unit, Sapienza University, AOU Policlinico Umberto I, Rome, Italy., Florman SS; Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York, USA., Tabrizian P; Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York, USA., Haydel B; Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York, USA., Ruiz RM; Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA., Klintmalm GB; Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA., Lee DD; Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA., Taner CB; Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA., Hoteit M; Penn Transplant Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Levine MH; Penn Transplant Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Cillo U; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.; New York-Presbyterian Hospital, Weill Cornell, New York, New York, USA., Vitale A; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.; New York-Presbyterian Hospital, Weill Cornell, New York, New York, USA., Verna EC; New York-Presbyterian Hospital, Columbia University, New York, New York, USA., Halazun KJ; New York-Presbyterian Hospital, Columbia University, New York, New York, USA., Tevar AD; Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Humar A; Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Chapman WC; Section of Transplantation, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA., Vachharajani N; Section of Transplantation, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA., Aucejo F; Cleveland Clinic Foundation, Cleveland, Ohio, USA., Lerut J; Department of Abdominal and Transplantation Surgery, Institute for Experimental and Clinical Research, Universite Catholique Louvain, Brussels, Belgium., Ciccarelli O; Department of Abdominal and Transplantation Surgery, Institute for Experimental and Clinical Research, Universite Catholique Louvain, Brussels, Belgium., Nguyen MH; Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA., Melcher ML; Department of Surgery, Stanford University, Palo Alto, California, USA., Viveiros A; Department of Medicine I, Medical University of Innsbruck, Innsbruck, Austria., Schaefer B; Department of Medicine I, Medical University of Innsbruck, Innsbruck, Austria., Hoppe-Lotichius M; Clinic for General, Visceral and Transplantation Surgery, Universitatsmedizin Mainz, Mainz, Germany., Mittler J; Clinic for General, Visceral and Transplantation Surgery, Universitatsmedizin Mainz, Mainz, Germany., Nydam TL; Department of Surgery, Division of Transplant Surgery, University of Colorado School of Medicine, Denver, Colorado, USA., Markmann JF; Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Rossi M; General Surgery and Organ Transplantation Unit, Sapienza University, AOU Policlinico Umberto I, Rome, Italy., Mobley C; Sherrie & Alan Conover Center for Liver Disease & Transplantation, Houston Methodist Hospital, Houston, Texas, USA., Ghobrial M; Sherrie & Alan Conover Center for Liver Disease & Transplantation, Houston Methodist Hospital, Houston, Texas, USA., Langnas AN; Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA., Carney CA; Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA., Berumen J; Department of Surgery, Division of Transplantation and Hepatobiliary Surgery, University of California, San Diego, San Diego, California, USA., Schnickel GT; Department of Surgery, Division of Transplantation and Hepatobiliary Surgery, University of California, San Diego, San Diego, California, USA., Sudan DL; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA., Hong JC; Department of Hepatobiliary Surgery & Transplantation, Division of Transplantation, Penn State College of Medicine, Hershey, Pennsylvania, USA., Rana A; Department of Surgery, Baylor College of Medicine, Houston, Texas, USA., Jones CM; Section of Hepatobiliary and Transplant Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA., Fishbein TM; Medstar Georgetown Transplant Institute, Georgetown University, Washington, District of Columbia, USA., Busuttil RW; Department of Surgery, David Geffen School of Medicine at UCLA, Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Centers, Los Angeles, California, USA., Barbas AS; Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA., Agopian VG; Department of Surgery, David Geffen School of Medicine at UCLA, Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Centers, Los Angeles, California, USA.
Jazyk:	angličtina
Zdroj:	Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2023 Jul 01; Vol. 29 (7), pp. 683-697. Date of Electronic Publication: 2023 Apr 10.
DOI:	10.1097/LVT.0000000000000145
Abstrakt:	HCC recurrence following liver transplantation (LT) is highly morbid and occurs despite strict patient selection criteria. Individualized prediction of post-LT HCC recurrence risk remains an important need. Clinico-radiologic and pathologic data of 4981 patients with HCC undergoing LT from the US Multicenter HCC Transplant Consortium (UMHTC) were analyzed to develop a REcurrent Liver cAncer Prediction ScorE (RELAPSE). Multivariable Fine and Gray competing risk analysis and machine learning algorithms (Random Survival Forest and Classification and Regression Tree models) identified variables to model HCC recurrence. RELAPSE was externally validated in 1160 HCC LT recipients from the European Hepatocellular Cancer Liver Transplant study group. Of 4981 UMHTC patients with HCC undergoing LT, 71.9% were within Milan criteria, 16.1% were initially beyond Milan criteria with 9.4% downstaged before LT, and 12.0% had incidental HCC on explant pathology. Overall and recurrence-free survival at 1, 3, and 5 years was 89.7%, 78.6%, and 69.8% and 86.8%, 74.9%, and 66.7%, respectively, with a 5-year incidence of HCC recurrence of 12.5% (median 16 months) and non-HCC mortality of 20.8%. A multivariable model identified maximum alpha-fetoprotein (HR = 1.35 per-log SD, 95% CI,1.22-1.50, p < 0.001), neutrophil-lymphocyte ratio (HR = 1.16 per-log SD, 95% CI,1.04-1.28, p < 0.006), pathologic maximum tumor diameter (HR = 1.53 per-log SD, 95% CI, 1.35-1.73, p < 0.001), microvascular (HR = 2.37, 95%-CI, 1.87-2.99, p < 0.001) and macrovascular (HR = 3.38, 95% CI, 2.41-4.75, p < 0.001) invasion, and tumor differentiation (moderate HR = 1.75, 95% CI, 1.29-2.37, p < 0.001; poor HR = 2.62, 95% CI, 1.54-3.32, p < 0.001) as independent variables predicting post-LT HCC recurrence (C-statistic = 0.78). Machine learning algorithms incorporating additional covariates improved prediction of recurrence (Random Survival Forest C-statistic = 0.81). Despite significant differences in European Hepatocellular Cancer Liver Transplant recipient radiologic, treatment, and pathologic characteristics, external validation of RELAPSE demonstrated consistent 2- and 5-year recurrence risk discrimination (AUCs 0.77 and 0.75, respectively). We developed and externally validated a RELAPSE score that accurately discriminates post-LT HCC recurrence risk and may allow for individualized post-LT surveillance, immunosuppression modification, and selection of high-risk patients for adjuvant therapies. (Copyright © 2023 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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