Recurrent Hepatocellular Carcinoma After Liver Transplantation: Validation of a Pathologic Risk Score on Explanted Livers to Predict Recurrence
Autor: | Jeremy Parfitt, Salman Aziz, Karim Qumosani, Anton I. Skaro, Mayur Brahmania, Michael Sey, Paul Marotta, Anouar Teriaky, David K. Driman |
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Rok vydání: | 2021 |
Předmět: |
Transplantation
medicine.medical_specialty Carcinoma Hepatocellular Framingham Risk Score Optimal cutoff Receiver operating characteristic business.industry medicine.medical_treatment Liver Neoplasms Liver transplantation medicine.disease Lower risk Gastroenterology Recurrent Hepatocellular Carcinoma Liver Transplantation Risk groups Risk Factors Hepatocellular carcinoma Internal medicine medicine Humans Surgery Neoplasm Recurrence Local business Retrospective Studies |
Zdroj: | Transplantation Proceedings. 53:1975-1979 |
ISSN: | 0041-1345 |
Popis: | BACKGROUND Recurrence of hepatocellular carcinoma (HCC) after liver transplantation is a major cause of morbidity and mortality. To date, there is no widely accepted pathologic assessment tool to predict HCC recurrence. In 2007, we developed a pathologic risk score that stratified patients into low, intermediate, or high risk for recurrence based on explant pathology. The aim of this study was to externally validate this risk score. METHODS We retrospectively evaluated 124 patients over a 10-year period who underwent liver transplantation for HCC. Using explanted pathology reports, each patient was stratified according to the pathologic risk score and followed over time for HCC recurrence. RESULTS Recurrence occurred in 15 patients (12%) after a mean follow-up of 25 months. Using the pathologic risk score, 10 (8%), 21 (17%), and 93 (75%) patients were stratified into high, intermediate, and low risk of recurrence, respectively. Among these risk groups, recurrence occurred in 50%, 28.5%, and 4.3% (P < .01) of patients, respectively. Using the optimal cutoff value ≤3.5, our risk score had a sensitivity of 80% and specificity of 79% with an area under the receiver operator characteristic curve of 0.8. Those with lower risk scores had higher recurrence-free survival (P < .0001). CONCLUSIONS Our pathologic risk score accurately risks stratified patients for HCC recurrence after liver transplant. It can be used to tailor surveillance strategies for those deemed to be at elevated risk for recurrence. |
Databáze: | OpenAIRE |
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