Comparative analysis and validation of models and criteria for predicting hepatocellular carcinoma recurrence after liver transplantation

Aim. To evaluate the accuracy and feasibility of using the most common criteria and models for predicting the survival and risk of hepatocellular carcinoma recurrence in clinical practice based on own experience in liver transplantation.

Materials and methods. The single-center retrospective study included data on 70 patients who underwent transplantation from May 2010 to December 2022. Compliance with the criteria (Milan, UCSF, 5-5-500, etc.) was determined and the values of predictive models (Metroticket 2.0, Pre-ALRAL, etc.) were calculated for each observation. Survival rates, as well as efficiency of criteria and models were analyzed using sensitivity, specificity, F1 score, and C-index.

Results. At the time of transplantation, the interquartile range for the number of tumors comprised 1–3, tumor sizes ranged from 1.8 to 5 cm, total tumor size ranged from 2.4 to 8.5 cm, and alpha-fetoprotein levels accounted for 14.7–150 ng/mL. During the follow-up period, hepatocellular carcinoma recurrence was recorded in 26% of patients. Disease-free and overall survival at 1, 3, and 5 years amounted to 89%, 76%, 63%, and 89%, 74.3%, 68%, respectively. The F1 score and C-index for predicting hepatocellular carcinoma recurrence after liver transplantation varied from 0.65 to 0.83, with the 5-5-500 criterion demonstrating the best performance. This criterion provided a five-year disease-free survival rate of 86% and an overall survival rate of 79%, with non-compliance leading to a decrease in survival to 33% and 46%.

Conclusion. The studied criteria and models can be used to assess the risk of hepatocellular carcinoma recurrence after liver transplantation, although their predictive accuracy remains imperfect. An online calculator has been created to assess patient compliance with criteria and to predict disease-free and overall survival (https://nadit.ru/criterii). The development of own model and criteria within the framework of a Russian multicenter study, as well as the search for new objective methods for assessing the risk of hepatocellular carcinoma recurrence after liver transplantation, remain promising research areas.

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