Explant-based prognostic models for hepatocellular carcinoma recurrence after liver transplantation: A systematic review and meta-analysis

Table 1 Baseline characteristics of patients, and allocation criteria for hepatocellular carcinoma transplantation in the studies included in systematic review

Ref.	Age (years)	Male (%)	Etiology of liver disease (%)	Hepatocellular carcinoma allocation criteria	Within Milan criteria (%)	Loco regional therapy1 (%)
Parfitt et al[24], 2007	54	84	HCV (42.7%), alcohol (21.3%), HBV (17.3%)	N/A	66.72	N/A
Chan et al[19], 2008	56.2	89.7	HCV (58%), HBV (33%), alcohol (17%)	N/A	N/A	N/A
Agopian et al[21], 2015	59.5	73.3	HCV (58%), HBV (16%), alcohol (9%)	Milan/UCSF	84	60
Mehta et al[12], 2017	58.2	75.2	HCV (58.8%), HBV (16.1%), MAFLD (8.0%)	Milan	50.32	91.5
Halazun et al[25], 2017	57.8	79.9	HCV (69.3%), HBV (15.3%), alcohol (11.8%)	Milan	66.6	81.7
Costentin et al[13], 2017	52.7	85.2	HBV or HCV (61.8%), alcohol (28.8%), others (9.4%)	Milan	64.22	67.7
Mehta et al[14], 2018	60	76.7	HCV (62.8%), MAFLD (8.0%), alcohol (7.3%)	Milan	852	91.1
Mirón Fernández et al[15], 2019	56.2	76.2	HCV (39%), mixed (alcohol/HCV): (22.9%), HBV (16.2%)	N/A	59.4	N/A
Feng et al[26], 2019	59	82.2	HBV (88.1%), HCV (5.9%), alcohol (2%)	Milan	79.22	75
Sánchez Segura et al[27], 2020	59	82.8	HCV (38.4%), alcohol (25.3%), mixed (alcohol/HCV): (23.2%)	N/A	62.6	94.9
Hasan et al[28], 2021	65.5	75	HCV (55.8%), MAFLD (25%), alcohol (5.8%)	Milan	100	58
Ma et al[29], 2021	51.98	92.1	HCV (54.9%), alcohol (23.5%), HBV (7.8%)	N/A	37.12	N/A
Abdelfattah et al[11], 2021	57.1	68.5	HCV (60.3%), HBV (26%), others (13.7%)	Milan	100	N/A
Åberg et al[16], 2021	57.4	79.3	HCV (59.2%), alcohol (28.4%), HBV (17.9%)	N/A	61.52	35.7
Aziz et al[30], 2021	62	89	HCV (46%), alcohol (11%), HBV (5%)	Milan/UCSF/total tumor volume < 15 cm3	49.3	68.5
Costentin et al[22], 2022	58	82.7	HBV or HCV (57.8%), alcohol (31.3%), others (10.8%)	Milan/alpha-fetoprotein score	62.32	68.5
Reddy et al[17], 2022	59	73.8	HCV (41.9%), alcohol (18.5%), HBV (11.2%)	Revised United Kingdom criteria	84.3	76.4
Van Hooff et al[18], 2022	61.2	79.8	HCV (20.7%), alcohol (16.3%), HBV (13.8%)	N/A	79.32	75.4
Cuadrado et al[31], 2023	60	87.9	Alcohol (34.8%), HCV (31.8%), mixed (alcohol/HCV): (19.7%)	N/A	98.5	77.3
Tran et al[23], 2023	58.0	77.9	HCV (61.6%), alcohol (10.7%), HBV (10.6%)	Milan	71.9	86.2
Brandão et al[32], 2024	60.5	71.9	HCV (87.5%), alcohol (9.4%), HBV (3.1%)	Brazilian Milan criteria	71.6	65.2

¹Loco regional therapy (includes downstaging in some studies).

²Based on explant pathology.

HBV: Hepatitis B virus; HCV: Hepatitis C virus; MAFLD: Metabolic dysfunction-associated fatty liver disease; N/A: Not available; UCSF: University of California, San Francisco.

Table 2 Sensitivity, specificity and area under the curve by bivariate analyses for different thresholds of the meta-analyzed scores

Bivariate analysis
Score	Sensibility	Sensibility 95%CI	Specificity	Specificity 95%CI	AUC	AUC 95%CI
RETREAT ≥ 5	0.386	0.252-0.540	0.950	0.897-0.976	0.793	0.406-0.945
RETREAT ≥ 4	0.601	0.443-0.740	0.861	0.759-0.924	0.807	0.611-0.880
RETREAT ≥ 3	0.686	0.560-0.790	0.736	0.647-0.810	0.771	0.704-0.809
PCRS ≥ 1	0.582	0.306-0.815	0.851	0.797-0.893	0.852	0.521-0.905
PCRS ≥ 3	0.223	0.154-0.311	0.950	0.915-0.971	0.431	0.246-0.952
Decaens ≥ 4	0.591	0.329-0.810	0.821	0.597-0.934	0.772	0.518-0.889

AUC: Area under the curve; PCRS: Predicting cancer recurrence score; RETREAT: Risk estimation of tumor recurrence after transplant.

Table 3 Comparison matrix of area under the curves scores

Score	RETREAT ≥ 5	RETREAT ≥ 4	RETREAT ≥ 3	PCRS ≥ 1	PCRS ≥ 3	Decaens ≥ 4
RETREAT ≥ 5	-	0.963	0.860	0.809	0.941	0.913
RETREAT ≥ 4	0.963	-	0.632	0.697	0.956	0.779
RETREAT ≥ 3	0.860	0.632	-	0.382	0.931	0.948
PCRS ≥ 1	0.809	0.697	0.382	-	0.903	0.545
PCRS ≥ 3	0.941	0.956	0.931	0.903	-	0.940
Decaens ≥ 4	0.913	0.779	0.948	0.545	0.940	-

PCRS: Predicting cancer recurrence score; RETREAT: Risk estimation of tumor recurrence after transplant.