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Charting the Path Forward for Risk Prediction in Liver Transplant for Hepatocellular Carcinoma: International Validation of HALTHCC Among 4,089 Patients.

Publication ,  Journal Article
Firl, DJ; Sasaki, K; Agopian, VG; Gorgen, A; Kimura, S; Dumronggittigule, W; McVey, JC; Iesari, S; Mennini, G; Vitale, A; Finkenstedt, A ...
Published in: Hepatology (Baltimore, Md.)
February 2020

Prognosticating outcomes in liver transplant (LT) for hepatocellular carcinoma (HCC) continues to challenge the field. Although Milan Criteria (MC) generalized the practice of LT for HCC and improved outcomes, its predictive character has degraded with increasing candidate and oncological heterogeneity. We sought to validate and recalibrate a previously developed, preoperatively calculated, continuous risk score, the Hazard Associated with Liver Transplantation for Hepatocellular Carcinoma (HALTHCC), in an international cohort. From 2002 to 2014, 4,089 patients (both MC in and out [25.2%]) across 16 centers in North America, Europe, and Asia were included. A continuous risk score using pre-LT levels of alpha-fetoprotein, Model for End-Stage Liver Disease Sodium score, and tumor burden score was recalibrated among a randomly selected cohort (n = 1,021) and validated in the remainder (n = 3,068). This study demonstrated significant heterogeneity by site and year, reflecting practice trends over the last decade. On explant pathology, both vascular invasion (VI) and poorly differentiated component (PDC) increased with increasing HALTHCC score. The lowest-risk patients (HALTHCC 0-5) had lower rates of VI and PDC than the highest-risk patients (HALTHCC > 35) (VI, 7.7%[ 1.2-14.2] vs. 70.6% [48.3-92.9] and PDC:4.6% [0.1%-9.8%] vs. 47.1% [22.6-71.5]; P < 0.0001 for both). This trend was robust to MC status. This international study was used to adjust the coefficients in the HALTHCC score. Before recalibration, HALTHCC had the greatest discriminatory ability for overall survival (OS; C-index = 0.61) compared to all previously reported scores. Following recalibration, the prognostic utility increased for both recurrence (C-index = 0.71) and OS (C-index = 0.63). Conclusion: This large international trial validated and refined the role for the continuous risk metric, HALTHCC, in establishing pre-LT risk among candidates with HCC worldwide. Prospective trials introducing HALTHCC into clinical practice are warranted.

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Published In

Hepatology (Baltimore, Md.)

DOI

EISSN

1527-3350

ISSN

0270-9139

Publication Date

February 2020

Volume

71

Issue

2

Start / End Page

569 / 582

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Liver Transplantation
  • Liver Neoplasms
  • International Cooperation
  • Humans
  • Gastroenterology & Hepatology
 

Citation

APA
Chicago
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MLA
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Firl, D. J., Sasaki, K., Agopian, V. G., Gorgen, A., Kimura, S., Dumronggittigule, W., … Aucejo, F. N. (2020). Charting the Path Forward for Risk Prediction in Liver Transplant for Hepatocellular Carcinoma: International Validation of HALTHCC Among 4,089 Patients. Hepatology (Baltimore, Md.), 71(2), 569–582. https://doi.org/10.1002/hep.30838
Firl, Daniel J., Kazunari Sasaki, Vatche G. Agopian, Andre Gorgen, Shoko Kimura, Wethit Dumronggittigule, John C. McVey, et al. “Charting the Path Forward for Risk Prediction in Liver Transplant for Hepatocellular Carcinoma: International Validation of HALTHCC Among 4,089 Patients.Hepatology (Baltimore, Md.) 71, no. 2 (February 2020): 569–82. https://doi.org/10.1002/hep.30838.
Firl DJ, Sasaki K, Agopian VG, Gorgen A, Kimura S, Dumronggittigule W, et al. Charting the Path Forward for Risk Prediction in Liver Transplant for Hepatocellular Carcinoma: International Validation of HALTHCC Among 4,089 Patients. Hepatology (Baltimore, Md). 2020 Feb;71(2):569–82.
Firl, Daniel J., et al. “Charting the Path Forward for Risk Prediction in Liver Transplant for Hepatocellular Carcinoma: International Validation of HALTHCC Among 4,089 Patients.Hepatology (Baltimore, Md.), vol. 71, no. 2, Feb. 2020, pp. 569–82. Epmc, doi:10.1002/hep.30838.
Firl DJ, Sasaki K, Agopian VG, Gorgen A, Kimura S, Dumronggittigule W, McVey JC, Iesari S, Mennini G, Vitale A, Finkenstedt A, Onali S, Hoppe-Lotichius M, Vennarecci G, Manzia TM, Nicolini D, Avolio AW, Agnes S, Vivarelli M, Tisone G, Ettorre GM, Otto G, Tsochatzis E, Rossi M, Viveiros A, Cillo U, Markmann JF, Ikegami T, Kaido T, Lai Q, Sapisochin G, Lerut J, European Hepatocellular Cancer Liver Transplant Study Group, Aucejo FN. Charting the Path Forward for Risk Prediction in Liver Transplant for Hepatocellular Carcinoma: International Validation of HALTHCC Among 4,089 Patients. Hepatology (Baltimore, Md). 2020 Feb;71(2):569–582.
Journal cover image

Published In

Hepatology (Baltimore, Md.)

DOI

EISSN

1527-3350

ISSN

0270-9139

Publication Date

February 2020

Volume

71

Issue

2

Start / End Page

569 / 582

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Liver Transplantation
  • Liver Neoplasms
  • International Cooperation
  • Humans
  • Gastroenterology & Hepatology