Objective: This study aims to validate a previously reported recurrence clinical risk score (CRS). Summary of Background Data: Salvage transplantation after hepatocellular carcinoma (HCC) resection is limited to patients who recur within Milan criteria (MC). Predicting recurrence patterns may guide treatment recommendations. Methods: An international, multicenter cohort of R0 resected HCC patients were categorized by MC status at presentation. CRS was calculated by assigning 1 point each for initial disease beyond MC, multinodularity, and microvascular invasion. Recurrence incidences were estimated using competing risks methodology, and conditional recurrence probabilities were estimated using the Bayes theorem. Results: From 1992 to 2015, 1023 patients were identified, of whom 613 (60%) recurred at a median follow-up of 50 months. CRS was well validated in that all 3 factors remained independent predictors of recurrence beyond MC (hazard ratio 1.5-2.1, all P < 0.001) and accurately stratified recurrence risk beyond MC, ranging from 19% (CRS 0) to 67% (CRS 3) at 5 years. Among patients with CRS 0, no other factors were significantly associated with recurrence beyond MC. The majority recurred within 2 years. After 2 years of recurrence-free survival, the cumulative risk of recurrence beyond MC within the next 5 years for all patients was 14%. This risk was 12% for patients with initial disease within MC and 17% for patients with initial disease beyond MC. Conclusions: CRS accurately predicted HCC recurrence beyond MC in this international validation. Although the risk of recurrence beyond MC decreased over time, it never reached zero.

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doi.org/10.1097/SLA.0000000000002360, hdl.handle.net/1765/108471
Annals of Surgery
Erasmus MC: University Medical Center Rotterdam

Zheng, J. (Jian), Chou, J.F. (Joanne F.), Gonen, M., Vachharajani, N. (Neeta), Chapman, W. C., Majella Doyle, M.B. (Maria B.), … Lee, S.Y. (Ser Yee). (2017). Prediction of Hepatocellular Carcinoma Recurrence beyond Milan Criteria after Resection. In Annals of Surgery (Vol. 266, pp. 693–701). doi:10.1097/SLA.0000000000002360