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A Novel Prognostic Nomogram Accurately Predicts Hepatocellular Carcinoma Recurrence after Liver Transplantation: Analysis of 865 Consecutive Liver Transplant.

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Presentation on theme: "A Novel Prognostic Nomogram Accurately Predicts Hepatocellular Carcinoma Recurrence after Liver Transplantation: Analysis of 865 Consecutive Liver Transplant."— Presentation transcript:

1 A Novel Prognostic Nomogram Accurately Predicts Hepatocellular Carcinoma Recurrence after Liver Transplantation: Analysis of 865 Consecutive Liver Transplant Recipients  Vatche G. Agopian, MD, Michael Harlander-Locke, MPH, Ali Zarrinpar, MD, PhD, Fady M. Kaldas, MD, FACS, Douglas G. Farmer, MD, FACS, Hasan Yersiz, MD, Richard S. Finn, MD, Myron Tong, MD, Jonathan R. Hiatt, MD, FACS, Ronald W. Busuttil, MD, PhD, FACS  Journal of the American College of Surgeons  Volume 220, Issue 4, Pages (April 2015) DOI: /j.jamcollsurg Copyright © 2015 American College of Surgeons Terms and Conditions

2 Figure 1 Cumulative incidence curves demonstrating overall survival, recurrence-free survival, death not related to hepatocellular carcinoma, and post-transplant hepatocellular carcinoma (HCC) recurrence at 1-, 3-, and 5-years after liver transplantation (LT). Journal of the American College of Surgeons  , DOI: ( /j.jamcollsurg ) Copyright © 2015 American College of Surgeons Terms and Conditions

3 Figure 2 Kaplan-Meier recurrence-free survival curves with 1-, 3-, and 5-year estimates comparing (A) recipients within Milan criteria (MC), outside MC and downstaged to MC, and outside MC not downstaged to MC and (B) recipients within MC with and without previous bridging pretransplantation HCC treatment. Journal of the American College of Surgeons  , DOI: ( /j.jamcollsurg ) Copyright © 2015 American College of Surgeons Terms and Conditions

4 Figure 3 Kaplan-Meier recurrence-free survival curves with 1-, 3-, and 5-year estimates comparing recipients based on presence or absence of vascular invasion. Journal of the American College of Surgeons  , DOI: ( /j.jamcollsurg ) Copyright © 2015 American College of Surgeons Terms and Conditions

5 Figure 4 Kaplan-Meier recurrence-free survival curves with 1-, 3-, and 5-year estimates comparing recipients based on the American Joint Committee on Cancer (AJCC) pathologic T stage. Journal of the American College of Surgeons  , DOI: ( /j.jamcollsurg ) Copyright © 2015 American College of Surgeons Terms and Conditions

6 Figure 5 Forrest plot demonstrating multivariate predictors of post-transplantation hepatocellular carcinoma (HCC) recurrence in descending order of hazard ratios (HR). *HR per log SD increase for neutrophil-to-lymphocyte ratio (NLR) and pretransplantation maximum alpha fetoprotein (AFP). **HR per SD increase of total cholesterol. Journal of the American College of Surgeons  , DOI: ( /j.jamcollsurg ) Copyright © 2015 American College of Surgeons Terms and Conditions

7 Figure 6 Plot demonstrating post-transplantation recurrence risk based on calculated risk score (R). For any given R, the estimated 1-, 3-, and 5-year recurrence risk can be obtained from the corresponding graph. This model had an excellent overall accuracy, with a C statistic of 0.85. Journal of the American College of Surgeons  , DOI: ( /j.jamcollsurg ) Copyright © 2015 American College of Surgeons Terms and Conditions

8 Figure 7 Novel clinicopathologic prognostic nomogram for predicting post-transplantation hepatocellular carcinoma (HCC) recurrence. For each predictor, a straight upward line is drawn to determine the points accrued. The cumulative points are plotted on the total points bar, and a straight downward line yields the 1-, 3-, and 5-year estimated post-transplantation recurrence risk. Nuclear grade: 1 = grade 1–2, well differentiated; 2 = grade 2–3, moderately to poorly differentiated; 3 = grade 4, poorly differentiated; 4 = unknown grade due to complete tumor necrosis on pathology. Vascular invasion: 1= none, 2 = microvascular, 3 = macrovascular. Downstaging: 1 = Within Milan or downstaged to Milan, 2 = outside Milan and not downstaged. Radiologic maximum tumor diameter: 1 = incidental, 2 = nonincidental <5 cm, 3 = nonincidental ≥5 cm. Alpha fetoprotein (AFP), neutrophil-to-lymphocyte ratio (NLR), and total cholesterol plotted on original scale. Journal of the American College of Surgeons  , DOI: ( /j.jamcollsurg ) Copyright © 2015 American College of Surgeons Terms and Conditions


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