Ann Surg Treat Res.  2022 Mar;102(3):131-138. 10.4174/astr.2022.102.3.131.

Validation for models for tumor recurrence after liver transplantation in hepatectomy patients

• Kim SJ
• Kim JM
• Yi NJ
• Choi GS
• Lee KW
• Suh KS
• Joh JW

• KMID: 2526933
• DOI: http://doi.org/10.4174/astr.2022.102.3.131

Abstract

Purpose
Early recurrence of hepatocellular carcinoma (HCC) remains a challenging issue after hepatic resection (HR) because of the associated poor prognosis. Models for tumor recurrence after liver transplantation (MoRAL) have been designed to predict tumor recurrence in HCC patients in the liver transplantation setting. This study aimed to validate the predictability of MoRAL for HCC recurrence or patient death and to evaluate the predictors of early HCC recurrence in hepatectomy patients with treatment-naïve solitary HCC.
Methods
This study included 443 patients with HCC recurrence after HR from January 2005 to December 2011. Patients were stratified into early recurrence (n = 312) and late recurrence (n = 131) groups according to the development of recurrence either within or more than 2 years after hepatectomy.
Results
The median levels of alpha-fetoprotein and protein induced by vitamin K absence-II and the median MoRAL score were significantly higher in the early recurrence group than in the late recurrence group. Regarding pathologic characteristics, the median tumor size, prevalence of tumor grade 3 or 4, microvascular invasion, presence of tumor necrosis, and macrovascular invasion in the early recurrence group were greater than those in the late recurrence group. Multivariate analysis showed that tumor grade 3 or 4, microvascular invasion, and high preoperative MoRAL score were predisposing factors for early HCC recurrence after HR.
Conclusion
The MoRAL score can be used to predict early recurrence in patients with HCC who undergo curative HR. Using this model, other treatments could be considered for patients with early recurrence predicted after HR.

Keyword

Biochemical tumor markers; Hepatocellular carcinoma; Neoplasm recurrence; Prognosis

Figure

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  Fig. 1 Comparison of hepatocellular carcinoma (HCC) recurrence and death after hepatic resection between early and late recurrence groups.

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  Fig. 2 Comparison of hepatocellular carcinoma (HCC) recurrence and death from first HCC recurrence between the early and late recurrence groups.

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  Fig. 3 Comparison of hepatocellular carcinoma (HCC) recurrence and death after hepatic resection according to the models for tumor recurrence after liver transplantation (MoRAL) score.

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  Fig. 4 Comparison of hepatocellular carcinoma (HCC) recurrence and death from first HCC recurrence according to the models for tumor recurrence after liver transplantation (MoRAL) score.

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