Number of hepatocellular carcinoma nodules in patients listed for liver transplantation within alpha‐fetoprotein score: a new prognostic risk factor

Mazzotta, Alessandro; Pascale, Alina; Cano, Luis; Rosmorduc, Olivier; Allard, Marc‐Antoine; Cunha, Antonio Sa; Adam, René; Cherqui, Daniel; Vibert, Éric; Golse, Nicolas

doi:10.1111/tri.13858

Cited by 12 publications

(10 citation statements)

References 23 publications

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“…The prognosis of NV-HCC patients is closely related to the number of nodules in the liver. Mazzotta et al reported that patients who had more than 5 HCC nodules during the waiting period had a high risk of post liver transplantation recurrence and death [ 27 ]. Markers of the inflammatory response, including LMR, SLR, lymphocytes, NLR, and CRP, play important roles in the progression of many cancers [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Establishment and validation of a novel prognostic model for non-virus-related hepatocellular carcinoma

Jiang

Chen

et al. 2022

Cancer Cell Int

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Objective The incidence of non-virus-related hepatocellular carcinoma (NV-HCC) in hepatocellular carcinoma (HCC) is steadily increasing. The aim of this study was to establish a prognostic model to evaluate the overall survival (OS) of NV-HCC patients. Methods Overall, 261 patients with NV-HCC were enrolled in this study. A prognostic model was developed by using LASSO-Cox regression analysis. The prognostic power was appraised by the concordance index (C-index), and the time-dependent receiver operating characteristic curve (TD-ROC). Kaplan–Meier (K–M) survival analysis was used to evaluate the predictive ability in the respective subgroups stratified by the prognostic model risk score. A nomogram for survival prediction was established by integrating the prognostic model, TNM stage, and treatment. Results According to the LASSO-Cox regression results, the number of nodules, lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI), alkaline phosphatase (ALP), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (SLR) and C-reactive protein (CRP) were included for prognostic model construction. The C-index of the prognostic model was 0.759 (95% CI 0.723–0.797) in the development cohort and 0.796 (95% CI 0.737–0.855) in the validation cohort, and its predictive ability was better than TNM stage and treatment. The TD-ROC showed similar results. K–M survival analysis showed that NV-HCC patients with low risk scores had a better prognosis (P < 0.05). A nomogram based on the prognostic model, TNM stage, and treatment was constructed with sufficient discriminatory power with C-indexes of 0.78 and 0.85 in the development and validation cohort, respectively. Conclusion For NV-HCC, this prognostic model could predict an OS benefit for patients, which may assist clinicians in designing individualized therapeutic strategies.

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Section: Discussionmentioning

confidence: 99%

Establishment and validation of a novel prognostic model for non-virus-related hepatocellular carcinoma

Jiang

Chen

et al. 2022

Cancer Cell Int

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“…The prognosis of NV-HCC patients is closely related to the number of nodules in the liver. Mazzotta et al reported that the patients had high risk of post liver transplantation recurrence and death who had more than 5 HCC nodules during the waiting period [27]. Markers of in ammatory response, including LMR, SLR, lymphocytes, NLR, and CRP, play important roles in the progression of many cancers [28,29].…”

Section: Discussionmentioning

confidence: 99%

Establishment and validation of a novel prognostic model for non-virus-related hepatocellular carcinoma

Chen

et al. 2022

Preprint

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Objective The incidence of non-virus-related hepatocellular carcinoma (NV-HCC) in hepatocellular carcinoma (HCC) is steadily increasing. The aim of this study is to establish a prognostic model to evaluate the overall survival (OS) of NV-HCC. Methods Overall, 261 patients with NV-HCC were enrolled in this study. A prognostic model was developed by using LASSO-Cox regression analysis. The prognostic power was appraised by the concordance index (C-index), and the time-dependent receiver operating characteristic curve (TD-ROC). The Kaplan-Meier (K-M) survival analysis was used to evaluate the predictive ability in respective subgroups stratified by prognostic model risk score. A nomogram for survival prediction was established by integrating prognostic model, TNM stage, and treatment. Results According to the LASSO-Cox regression result, number of nodules, lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI), alkaline phosphatase (ALP), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (SLR) and C-reactive protein (CRP) were included for prognostic model construction. The C-index of the prognostic model was 0.761(95%CI: 0.723 ~ 0.799) in the development and 0.795 (95%CI: 0.735 ~ 0.855) in the validation cohort, and its predictive ability better than TNM stage and treatment, the TD-ROC showed similar results. K-M survival analysis showed that NV-HCC patients with low-risk score had a better prognosis (P < 0.05). A nomogram based on prognostic model, TNM stage, and treatment was constructed with sufficient discriminatory power with C-index of 0.78 and 0.85 in the development and validation cohort, respectively. Conclusion For NV-HCC, the prognostic model could predict OS benefit for patients, which may be helpful to clinicians to give individualized therapeutic suggestions.

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“…The UCSF criteria might be considered a reasonable upper limit for applying downstaging protocols on a solely morphometric basis. However, in the all-comers cohort, a proportion of patients can be cured by LT, although the likelihood is clearly lower ( 20 , 21 ). Considering this, it might be ‘too restrictive’ or more precisely ‘too unspecific’, if patient selection for downstaging is only based on tumor size and number.…”

Section: Still Not Outdated: Morphometric Parameters—should There Be ...mentioning

confidence: 96%

Patient Selection for Downstaging of Hepatocellular Carcinoma Prior to Liver Transplantation—Adjusting the Odds?

Seehofer¹,

Petrowsky²,

Schneeberger³

et al. 2022

Transpl Int

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Background and Aims: Morphometric features such as the Milan criteria serve as standard criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Since it has been recognized that these criteria are too restrictive and do not adequately display the tumor biology, additional selection parameters are emerging.Methods: Concise review of the current literature on patient selection for downstaging and LT for HCC outside the Milan criteria.Results: The major task in patients outside the Milan criteria is the need for higher granularity with patient selection, since the benefit through LT is not uniform. The recent literature clearly shows that beneath tumor size and number, additional selection parameters are useful in the process of patient selection for and during downstaging. For initial patient selection, the alpha fetoprotein (AFP) level adds additional information to the size and number of HCC nodules concerning the chance of successful downstaging and LT. This effect is quantifiable using newer selection tools like the WE (West-Eastern) downstaging criteria or the Metroticket 2.0 criteria. Also an initial PET-scan and/or tumor biopsy can be helpful, especially in the high risk group of patients outside the University of California San Francisco (UCSF) criteria. After this entry selection, the clinical course during downstaging procedures concerning the tumor and the AFP response is of paramount importance and serves as an additional final selection tool.Conclusion: Selection criteria for liver transplantation in HCC patients are becoming more and more sophisticated, but are still imperfect. The implementation of molecular knowledge will hopefully support a more specific risk prediction for HCC patients in the future, but do not provide a profound basis for clinical decision-making at present.

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Number of hepatocellular carcinoma nodules in patients listed for liver transplantation within alpha‐fetoprotein score: a new prognostic risk factor

Cited by 12 publications

References 23 publications

Establishment and validation of a novel prognostic model for non-virus-related hepatocellular carcinoma

Establishment and validation of a novel prognostic model for non-virus-related hepatocellular carcinoma

Establishment and validation of a novel prognostic model for non-virus-related hepatocellular carcinoma

Patient Selection for Downstaging of Hepatocellular Carcinoma Prior to Liver Transplantation—Adjusting the Odds?

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