Serum Tumor Markers Provide Refined Prognostication in Selecting Liver Transplantation Candidate for Hepatocellular Carcinoma Patients Beyond the Milan Criteria
- Authors
- Lee, JH[Lee, Jeong-Hoon]; Cho, Y[Cho, Yuri]; Kim, HY[Kim, Hwi Young]; Cho, EJ[Cho, Eun Ju]; Lee, DH[Lee, Dong Hyeon]; Yu, SJ[Yu, Su Jong]; Lee, JW[Lee, Jae Woo]; Yi, NJ[Yi, Nam-Joon]; Lee, KW[Lee, Kwang-Woong]; Kim, SH[Kim, Seoung Hoon]; Kim, JM[Kim, Jong Man]; Joh, JW[Joh, Jae-Won]; Teperman, LW[Teperman, Lewis W.]; Park, JS[Park, James S.]; Kim, YJ[Kim, Yoon Jun]; Suh, KS[Suh, Kyung-Suk]; Yoon, JH[Yoon, Jung-Hwan]
- Issue Date
- May-2016
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- beyond the Milan criteria; hepatocellular carcinoma; living donor liver transplantation; MoRAL score
- Citation
- ANNALS OF SURGERY, v.263, no.5, pp.842 - 850
- Indexed
- SCIE
SCOPUS
- Journal Title
- ANNALS OF SURGERY
- Volume
- 263
- Number
- 5
- Start Page
- 842
- End Page
- 850
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/36711
- DOI
- 10.1097/SLA.0000000000001578
- ISSN
- 0003-4932
- Abstract
- Objective:To develop and validate a model to predict tumor recurrence after living donor liver transplantation (LDLT) (MoRAL) for hepatocellular carcinoma (HCC) beyond the Milan criteria (MC).Background:Some subgroups of HCC exceeding the MC experience substantial benefit from LDLT.Methods:This multicenter study included a total of 566 consecutive patients who underwent LDLT in Korea: the beyond-MC cohort (n = 205, the derivation [n = 92] and validation [n = 113] sets) and the within-MC cohort (n = 361). The primary endpoint was time-to-recurrence.Results:Using multivariate Cox proportional hazard model, we derived the MoRAL score using serum levels of protein induced by vitamin K absence-II and alpha-fetoprotein, which provided a good discriminant function on time-to-recurrence (concordance index = 0.88). Concordance index was maintained similarly on both internal and external validations (mean 0.87 and 0.84, respectively). At cut off of 314.8 (75th percentile value), a low MoRAL score (314.8) was associated with significantly longer recurrence-free (versus > 314.8, HR = 5.29, P < 0.001) and overall survivals (HR = 2.59, P = 0.001) in the beyond-MC cohort. The 5-year recurrence-free and overall survival rates of beyond-MC patients with a low MoRAL score were as high as 66.3% and 82.6%, respectively. The within-MC patients with a high MoRAL score showed a higher risk of recurrence than beyond-MC patients with a low MoRAL score (HR = 2.56, P = 0.035). The MoRAL score was significantly correlated with explant histology.Conclusions:This new model using protein induced by vitamin K absence-II and alpha-fetoprotein provides refined prognostication. Among beyond-MC HCC patients, those with a MoRAL score 314.8 and without extrahepatic metastasis might be potential candidates for LDLT.
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