Validation of the -fetoprotein Model for Hepatocellular Carcinoma Recurrence After Transplantation in an Asian Population

Background This study was designed to validate the -fetoprotein model for predicting recurrence after liver transplantation in Korean hepatocellular carcinoma patients. Methods Patients who underwent liver transplantation for hepatocellular carcinoma at Samsung Medical Center between 2007 and 2015 were included. Recurrence, overall survival, and disease-specific survival of patients divided by both the Milan criteria and the -fetoprotein model were compared using Kaplan-Meier log-rank test. The predictability of the -fetoprotein model compared with the Milan criteria was tested by means of net reclassification improvement analysis applied to patients with a follow-up of at least 2 years. Results A total of 400 patients were included in the study. Patients within Milan criteria had 5-year recurrence, and overall survival rates of 20.9% and 76.3%, respectively, compared with corresponding rates of 50.3% and 55.7%, respectively, for patients who were beyond Milan criteria. -Fetoprotein model low-risk patients had 5-year recurrence and overall survival rates of 21.1% and 76.2%, respectively, compared with corresponding rates of 57.7% and 52.2%, respectively, in high-risk patients (P < 0.001, all). Although overall net reclassification improvements were statistically nonsignificant for recurrence (net reclassification improvements [NRI] = 1.7%, Z = 0.30, P = 0.7624), and overall survival (NRI = 9.0%, Z = 1.60, P = 0.1098), they were significantly better for predicting no recurrence (NRI = 6.6%, Z = 3.16, P = 0.0016) and no death. (NRI = 7.7%, Z = 3.65, P = 0.0003). Conclusions The -fetoprotein model seems to be a promising tool for liver transplantation candidacy, but further investigation is needed.