Validated model for prediction of recurrent hepatocellular carcinoma after liver transplantation in Asian population

Table 1 Characteristics of the whole hepatocellular carcinoma population receiving liver transplantation

Characteristic	Total, n = 330
Age (yr, range)	56 (30-73)
Sex (male)	269 (81.5%)
Hepatitis B carrier (%)	81.6%
Waiting time from listing to transplantation (mo)	1 (0-89)
MELD	12.4 (6-59)
Size of tumor in explant (cm)	3(0.25-19.5)
No. of tumor nodules in explant One Two Three	163 (51.1%) 85 (26.6%) 28 (8.8%)
Within UCSF criteria	75%
Within Milan Criteria	65.6%
Serum AFP level before time of LT (ng/mL)	18.0 (1-117850)
Salvage LT (%)	71 (21.5%)
LDLT (%)	204 (61.8%)
Microvascular invasion (%)	97 (29.4%)
Well/mod differentiation (%)	271 (84.7%)
Operation duration (min)	671
Blood loss (mL)	2600 (200-30800)
Hospital mortality (%)	5 (1.6%)
Morbidity (ClavienIIIa or above) (%)	23.3%
Length of hospital stay (d)	16 (7-378)
Post-transplant HCC recurrence (%)	73 (23.9%)
Median disease-free survival (mo)	60.8 (0-263)
Median overall survival (mo)	65.4 (0-263)

MELD: Model of end-stage liver disease; UCSF: University of California at San Francisco; LT: Liver transplantation; AFP: Alpha fetoprotein; LDLT: Living donor liver transplantation; HCC: Hepatocellular carcinoma.

Table 2 Comparison of perioperative data between the training and validation sets

Characteristic	Training set, n = 183	Validation set, n = 147	P-value
Age	55 ( ± 7.1)	55 ( ± 7.0)	0.768
Sex (male, %)	80%	83%	0.570
HBsAg positivity (%)	82%	80.3%	0.777
MELD	14.7 (± 7.5)	13.8 (± 7.0)	0.284
Waiting time from listing to transplantation (mo)	1 (0-89)	1 (0-81)	0.051
Size of tumor in explant (cm)	3.0 (± 1.4)	3.3 (± 2.1)	0.116
No. of tumor nodules in explant	2.1 (± 1.8)	2.3 (± 2.5)	0.609
Serum AFP level before time of LT (ng/mL)	586 ( ± 3169)	1719 ( ± 10541)	0.169
Salvage LT (%)	19.1%	24.5%	0.281
LDLT (%)	112 (62.9%)	91 (61.9%)	0.908
Microvascular invasion (%)	28.8%	32.2%	0.713
Well/mod differentiation	87.5%	81.1%	0.237
HCC recurrence	24%	23.8%	1.000
5 yr disease-free survival (%)	78.8%	76.8%	0.733
5 yr overall survival (%)	80.8%	78.7%	0.733

HBsAg: Hepatitis B surface antigen; MELD: Model of end stage liver disease; AFP: Alpha fetoprotein; LT: Liver transplantation; LDLT: Living donor liver transplantation; Well/mod differentiation: Well or moderate differentiation; HCC: Hepatocellular carcinoma.

Table 3 Univariate and multivariate analyses for the training set

Variable	Univariate	Multivariate	HR (95%CI)
Sex	0.525	-	-
Age	0.062	-	-
Albumin	0.816	-	-
Platelet count	0.094	-	-
MELD	0.874	-	-
Tumor size in explant	0.059	-	-
Number of tumors in explant	0.007	NS	-
Microvascular invasion	0.895	-	-
Well/mod differentiation	0.811	-	-
Serum AFP level before LT ( ≥ 400 ng/mL)	0.002	0.012	2.92 (1.487-5.748)
Graft (g)/ESLW	0.083	-	-
Waiting time from listing to transplantation	0.77	-	-
Salvage LT	0.019	0.033	2.08 (1.063-4.081)
Milan criteria	0.052	NS	-
UCSF criteria	0.009	NS	-
Sum of tumor size and number	0.002	0.013	1.15 (1.03-1.28)

MELD: Model for end stage liver disease; Well/mod differentiation: Well or moderate differentiation; CI: Confidence interval; AFP: Alpha fetoprotein; LT: Liver transplantation; ESLW: Estimated standard liver weight; UCSF: University of California at San Francisco.