Including mRECIST in the Metroticket 2.0 criteria improves prediction of hepatocellular carcinoma-related death after liver transplant

JOURNAL OF HEPATOLOGY

卷:73

Article

Cucchetti, Alessandro^1,2  Serenari, Matteo^1,3  Sposito, Carlo^4,5,6  Di Sandro, Stefano⁷  Mosconi, Cristina³  Vicentin, Ilaria^6,8  Garanzini, Enrico⁹  Mazzaferro, Vincenzo^4,5,6  De Carlis, Luciano^7,10  Golfieri, Rita^3,11  Spreafico, Carlo⁹  Vanzulli, Angelo^6,8  Buscemi, Vincenzo⁷  Ravaioli, Matteo^1,3  Ercolani, Giorgio^1,2  Pinna, Antonio Daniele^1,3  Cescon, Matteo^1,3 

[1] Alma Mater Studiorum Univ Bologna, Dept Med & Surg Sci DIMEC, Via Albertoni 15, I-40138 Bologna, Italy

[2] Morgagni Pierantoni Hosp, Forli, Italy

[3] St Orsola Marcello Malpighi Hosp, Bologna, Italy

[4] Fdn IRCCS Ist Nazl Tumori Milano, Gen Surg & Liver Transplantat Unit, Milan, Italy

[5] Univ Milan, Milan, Italy

[6] Univ Milan, Dept Oncol & Hematooncol, Milan, Italy

[7] ASST Niguarda Hosp, Gen Surg & Abdominal Transplantat Unit, Milan, Italy

[8] ASST Niguarda Hosp, Dept Diagnost & Intervent Radiol, Milan, Italy

[9] Fdn IRCCS Ist Nazl Tumori Milano, Dept Radiol, Milan, Italy

[10] Univ Milano Bicocca, Dept Med & Surg, Milan, Italy

[11] Alma Mater Studiorum Univ Bologna, Dept Specialized Diagnost & Expt Med DIMES, Bologna, Italy

关键词: Hepatocellular carcinoma;    Liver transplant;    Neoadjuvant therapy;    Survival;    mRECIST;   

DOI  :  10.1016/j.jhep.2020.03.018

来源: Elsevier

【 摘 要 】

Background & Aims: In the context of liver transplantation (LT) for hepatocellular carcinoma (HCC), prediction models are used to ensure that the risk of post-LT recurrence is acceptably low. However, the weighting that 'response to neoadjuvant therapies' should have in such models remains unclear. Herein, we aimed to incorporate radiological response into the Metroticket 2.0 model for post-LT prediction of HCC-related death, to improve its clinical utility. Methods: Data from 859 transplanted patients (2000-2015) who received neoadjuvant therapies were included. The last radiological assessment before LT was reviewed according to the modified RECIST criteria. Competing-risk analysis was applied. The added value of including radiological response into the Metroticket 2.0 was explored through category-based net reclassification improvement (NRI) analysis. Results: At last radiological assessment prior to LT, complete response (CR) was diagnosed in 41.3%, partial response/stable disease (PR/SD) in 24.9% and progressive disease (PD) in 33.8% of patients. The 5-year rates of HCC-related death were 3.1%, 9.6% and 13.4% in those with CR, PR/SD, or PD, respectively (p <0.001). Log(10)AFP (p <0.001) and the sum of number and diameter of the tumour/s (p <0.05) were determinants of HCC-related death for PR/SD and PD patients. To maintain the post-LT 5-year incidence of HCC-related death <30%, the Metroticket 2.0 criteria were restricted in some cases of PR/SD and in all cases with PD, correctly reclassifying 9.4% of patients with HCC-related death, at the expense of 3.5% of patients who did not have the event. The overall/net NRI was 5.8. Conclusion: Incorporating the modified RECIST criteria into the Metroticket 2.0 framework can improve its predictive ability. The additional information provided can be used to better judge the suitability of candidates for LT following neoadjuvant therapies. Lay summary: In the context of liver transplantation for patients with hepatocellular carcinoma, prediction models are used to ensure that the risk of recurrence after transplantation is acceptably low. The Metroticket 2.0 model has been proposed as an accurate predictor of tumour-related death after liver transplantation. In the present study, we show that its accuracy can be improved by incorporating information relating to the radiological responses of patients to neoadjuvant therapies. (c) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free