OBJECTIVES: To identify the preoperative risk factors for prediction of non-transplantable recurrence (NTR) after tumor resection for early-stage hepatocellular carcinoma (HCC) to assist in patient selection relative toupfront liver resection (LR) versus livertransplantation (LT).METHODS: Patients who underwent curative resection for transplantable HCC and chronic liver disease were identified from an international multi-institutional database. NTR was defined as recurrence beyond the Milan or UCSF criteria, and the preoperative risk factors of NTR were investigated.RESULTS: Among 293 patients with transplantable HCC within Milan criteria and 320 within UCSF criteria, 113 (38.6%) and 131 (40.9%) patients developed tumor recurrence, respectively. Among patients who recurred, NTR was present in 32 (28.3%) patients within Milan and 35 (26.7%) within UCSF criteria. When either Milan or UCSF criteria was adopted, three preoperative risk factors including liver cirrhosis, tumor size>3cm, and multiple lesions were consistently identified as risk factors associated with NTR after curative resection. By summing up the three factors, a scoring model was established and the incidence of NTR among patients with 0,1 or=2 risk factors incrementally increased from 4.5%, 13.3% to 20.5% when Milan criteria was used, and from 4.5%, 12.4% to 33.9% when UCSF criteria was adopted. The model demonstratedvery good discriminatory power on internal validation (n=5,000) (c-index 0.689 for Milan criteria, and 0.715 for UCSF criteria).CONCLUSIONS: Whereas surgical resection may be optimal first-line treatment forpatients with no or one risk factor, patients with=2 risk factors should be considered for upfront liver transplantation.
View details for DOI 10.1007/s11605-021-05206-8
View details for PubMedID 34797558