A Model for Adaptive Decision Making of 'Ablate-and-Wait' Versus Transplantation in Patients with Hepatocellular Carcinoma

Hwi Young Kim, Won Kim, Yong Jin Jung, Jeong Hoon Lee, Su Jong Yu, Yoon Jun Kim, Jung Hwan Yoon, Hae Won Lee, Hyeyoung Kim, Nam Joon Yi, Kwang Woong Lee, Kyung Suk Suh

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1 Scopus citations

Abstract

Background/Aims: In patients with early-stage hepatocellular carcinoma (HCC), selection of candidates for liver transplantation (LT) requires refinement based on tumor biology to maximize the outcome. We aimed to prognosticate LT candidates with HCC using a risk prediction model for post-LT recurrence. Patients and Methods: A total of 197 consecutive patients were included who underwent LT for hepatitis B-related HCC within the Milan criteria. A risk prediction model was developed for post-LT recurrence using the Cox model and was internally validated. Results: Among those undergoing LT as their first HCC treatment (n=70, initial LT group), poor prognosis was associated with maximal tumor size and multinodularity. The remaining 127 patients (deferred LT group) received radiofrequency ablation (n=69) and/or transarterial chemoembolization (n=98) before LT. Multinodularity, maximal tumor size, posttransarterial chemoembolization progressive disease, baseline alpha-fetoprotein, and alpha-fetoprotein difference (between baseline and pre-LT) were incorporated into a risk prediction model for the deferred LT group, which was thereby stratified into low-risk (score<5), intermediate-risk, and high-risk (score?8) subgroups. Recurrence-free survival was significantly different among the deferred LT prognostic subgroups (P<0.001). Conclusions: This risk prediction model may help refinement of ablate-and-wait strategy for LT candidates by avoiding LT in those with either high risk score at baseline or increasing score under repeated locoregional therapies.

Original languageEnglish
Pages (from-to)655-661
Number of pages7
JournalJournal of Clinical Gastroenterology
Volume52
Issue number7
DOIs
StatePublished - 1 Aug 2018

Keywords

  • clinical decision making
  • hepatocellular carcinoma
  • transplantation

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