Development and Validation of a Pre-Transplant Risk Score (LT-MVI Score) to Predict Microvascular Invasion in Hepatocellular Carcinoma Candidates for Liver Transplantation

<b>Background/Objectives:</b> MVI is a relevant prognostic factor among patients with hepatocellular carcinoma (HCC) receiving liver transplantation (LT). The preoperative assessment of the risk for MVI is relevant to pre-LT patient management and selection. The objective of this study was to create and validate a model to predict microvascular invasion (MVI) based on preoperative variables in the LT setting. <b>Methods</b>: A total of 2170 patients from 11 collaborative centers in Europe, Asia, and the US, who received transplants between 1 January 2000 and 31 December 2017, were enrolled in the study. The entire cohort was split into a training and a validation set (70/30% of the initial cohort, respectively) using random selection. <b>Results</b>: MVI was reported in 586 (27.0%) explanted specimens. Using the training set data, multivariable logistic regression identified three preoperative parameters associated with MVI: α-fetoprotein (lnAFP; odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.13-1.27), imaging tumor burden score (lnTBS; OR = 1.66; 95%CI = 1.39-1.99), and a fast-track approach before LT due to the availability of a live donation (OR = 1.99; 95%CI = 1.56-2.53). In the validation set, the LT-MVI c-index was 0.74, versus 0.69 for the MVI score proposed by Endo et al. (Brier Skill Score +75%). The new score had a relevant net reclassification index (overall value = 0.61). Stratifying the validation set into three risk categories (0-50th, 51st-75th, and >75th score percentiles), a very good stratification was observed in terms of disease-free (5-year: 89.3, 75.5, and 50.7%, respectively) and overall survival (5-year: 79.5, 72.6, and 53.7%, respectively). <b>Conclusions</b>: The preoperative assessment of MVI using the proposed score demonstrated very good accuracy in predicting MVI after LT.

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Journal
Cancers
Published
2025-04-24
DOI
https://doi.org/10.3390/cancers17091418
Citations
1
Primary Topic
Hepatocellular Carcinoma Treatment and Prognosis
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article
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1.32
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article

Development and Validation of a Pre-Transplant Risk Score (LT-MVI Score) to Predict Microvascular Invasion in Hepatocellular Carcinoma Candidates for Liver Transplantation

Albert Chan, Maria Hoppe‐Lotichius, Prashant Bhangui, Marlene Panzer et al.
1 citations
Cancers
Hepatocellular Carcinoma Treatment and Prognosis
1.32
article

Development and Validation of a Pre-Transplant Risk Score (LT-MVI Score) to Predict Microvascular Invasion in Hepatocellular Carcinoma Candidates for Liver Transplantation

Albert Chan, Maria Hoppe‐Lotichius, Prashant Bhangui, Marlene Panzer, Umberto Cillo, Jens Mittler, Karim J. Halazun, Tomoharu Yoshizumi, Tiffany Wong, Etsuro Hatano, Timothy Michael Pawlik, Massimo Rossi, Jean Emond, Takeo Toshima, Takashi Ito, Laurent Coubeau, Alessandro Vitale, Quirino Lai, Jan Lerut, Benedikt Schaefer, Suela Ajdini, Arvinder S. Soin, Chih-Che Lin, Chao‐Long Chen
article en
1 citations

Abstract

<b>Background/Objectives:</b> MVI is a relevant prognostic factor among patients with hepatocellular carcinoma (HCC) receiving liver transplantation (LT). The preoperative assessment of the risk for MVI is relevant to pre-LT patient management and selection. The objective of this study was to create and validate a model to predict microvascular invasion (MVI) based on preoperative variables in the LT setting. <b>Methods</b>: A total of 2170 patients from 11 collaborative centers in Europe, Asia, and the US, who received transplants between 1 January 2000 and 31 December 2017, were enrolled in the study. The entire cohort was split into a training and a validation set (70/30% of the initial cohort, respectively) using random selection. <b>Results</b>: MVI was reported in 586 (27.0%) explanted specimens. Using the training set data, multivariable logistic regression identified three preoperative parameters associated with MVI: α-fetoprotein (lnAFP; odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.13-1.27), imaging tumor burden score (lnTBS; OR = 1.66; 95%CI = 1.39-1.99), and a fast-track approach before LT due to the availability of a live donation (OR = 1.99; 95%CI = 1.56-2.53). In the validation set, the LT-MVI c-index was 0.74, versus 0.69 for the MVI score proposed by Endo et al. (Brier Skill Score +75%). The new score had a relevant net reclassification index (overall value = 0.61). Stratifying the validation set into three risk categories (0-50th, 51st-75th, and >75th score percentiles), a very good stratification was observed in terms of disease-free (5-year: 89.3, 75.5, and 50.7%, respectively) and overall survival (5-year: 79.5, 72.6, and 53.7%, respectively). <b>Conclusions</b>: The preoperative assessment of MVI using the proposed score demonstrated very good accuracy in predicting MVI after LT.

CancersVol. 17(9)
Medanta The Medicity (IN), NewYork–Presbyterian Hospital (US), Kyushu University (JP), University of Padua (IT), Innsbruck Medical University (AT), Chang Gung University (TW), Universität Innsbruck (AT), Johannes Gutenberg University Mainz (DE), Kyoto University (JP), Policlinico Umberto I (IT), Queen Mary Hospital (CN), New York Hospital Queens (US), The Ohio State University Wexner Medical Center (US), NYU Langone Health (US), Kaohsiung Chang Gung Memorial Hospital (TW), Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie (DE), Columbia University (US), Sapienza University of Rome (IT), University of Hong Kong (HK), UCLouvain (BE)
Good health and well-being
Openalex Percentile: Top 21%
Hepatocellular Carcinoma Treatment and Prognosis
1.32
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