Development of a Nomogram Model to Predict Post-Transplant Tumor Recurrence in Patients with Hepatocellular Carcinoma Beyond the Milan Criteria Undergoing TACE Bridging Therapy

Hao Wang, Encheng Liu, Mei Wu, Haijun Gao, Bing Lv, Guang Chen, Xunjin Zeng Department of Radiology, Tianjin First Central Hospital, Tianjin, 300384, People’s Republic of ChinaCorrespondence: Guang Chen, Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300384, People’s Republic of China, Email [email protected] Xunjin Zeng, Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300384, People’s Republic of China, Email [email protected]: To develop a nomogram based on clinical characteristics for predicting post-transplant tumor recurrence in hepatocellular carcinoma (HCC) patients beyond the Milan criteria who received transarterial chemoembolization (TACE) bridging therapy.Methods: A retrospective analysis included 73 such patients (29 conventional TACE [cTACE], 44 drug-eluting bead TACE [DEB-TACE]) who underwent liver transplantation at our institution between January 2013 and January 2020, with follow-up until January 2024 (mean: 33.2 ± 6.5 months). Clinical/pathological features were analyzed via univariate and multivariate Cox regression to identify recurrence-related factors, and a nomogram was constructed. Bootstrap validation (B=20) and receiver operating characteristic (ROC) curves (AUC) evaluated its performance.Results: The 1-, 2-, 3-year cumulative recurrence rates were 17.8%, 23.3%, 24.7% (median recurrence time: 6 months). cTACE group rates (20.7%, 27.6%, 31.0%) were higher than DEB-TACE (15.9%, 20.5%, 20.5%; P=0.034). Independent risk factors: bridging therapy type (HR=2.402, P=0.034), microvascular invasion (HR=3.445, P=0.001), tumor necrosis rate (HR=26.664, P=0.002), pre-TACE AFP (HR=2.750, P=0.004). The nomogram’s AUC for 1-, 2-, 3-year recurrence was 0.740, 0.764, 0.886, with good calibration via bootstrap.Conclusion: A nomogram based on clinical characteristics accurately predicts post-transplant recurrence in HCC patients beyond the Milan criteria with TACE bridging therapy, providing guidance for optimizing donor allocation.Keywords: hepatocellular carcinoma, liver transplantation, drug-eluting beads, tumor recurrence