Table 3.
Univariate and multivariate analysis of predictors of hepatocellular carcinoma recurrence following liver transplantation, n (%)
|
|
No-recurrence (n = 209)
|
Recurrence (n = 25)
|
Univariate
|
Multivariate
|
||
|
HR (LL-UL 95%CI)
|
P value
|
HR (LL-UL 95%CI)
|
P value
|
|||
| LT era | ||||||
| 2010-2013 | 64 (30.6) | 7 (28.0) | 2.146 (0.446-10.330) | 0.341 | ||
| 2014-2017 | 106 (50.7) | 16 (64.0) | 2.700 (0.621-11.745) | 0.185 | ||
| 2018-2020 | 39 (18.7) | 2 (8.0) | 1.000 | |||
| RETREAT score | ||||||
| ≤ 3 | 135 (68.2) | 8 (32.0) | 1.000 | 1.000 | ||
| > 3 | 63 (31.8) | 17 (68.0) | 4.403 (1.900-10.206) | 0.001 | 1.011 (0.315-3.238) | 0.986 |
| Donor type | ||||||
| DBD | 110 (52.6) | 16 (64.0) | 1.475 (0.652-3.337) | 0.351 | ||
| DCD | 99 (47.4) | 9 (36.0) | 1.000 | |||
| Listing to transplant interval (months) | ||||||
| < 1 | 45 (21.5) | 9 (36.0) | 1.000 | |||
| 1-3 | 82 (39.2) | 6 (24.0) | 0.414 (0.147-1.164) | 0.095 | ||
| > 3 | 82 (39.2) | 10 (40.0) | 0.692 (0.281-1.704) | 0.423 | ||
| Within Milan criteria | 199 (95.2) | 24 (96.0) | 1.359 (0.184-10.046) | 0.764 | ||
| Within United Kingdom criteria | 204 (97.6) | 25 (100.0) | 0.048 (7.721 × 10-7–2965.3) | 0.589 | ||
| Tumour largest size (cm) | ||||||
| ≤ 5 | 203 (98.5) | 23 (95.8) | 1.000 | |||
| > 5 | 3 (1.5) | 1 (4.2) | 2.380 (0.321-17.629) | 0.396 | ||
| Number of tumours | ||||||
| ≤ 3 | 200 (96.6) | 25 (100.0) | 1.000 | |||
| > 3 | 7 (3.4) | 0 (0.0) | 0.047 (0.000-519.138) | 0.520 | ||
| AFP-listing | ||||||
| < 100 | 185 (89.8) | 20 (80.0) | 1.000 | 1.000 | ||
| 100-500 | 18 (8.7) | 3 (12.0) | 1.468 (0.436-4.941) | 0.536 | 0.723 (0.201-2.596) | 0.619 |
| > 500 | 3 (1.5) | 2 (8.0) | 5.170 (1.207-22.138) | 0.027 | 8.958 (1.689-47.503) | 0.010 |
| Bridging | 117 (56.0) | 21 (84.0) | 3.707 (1.272-10.801) | 0.016 | ||
| The trend of size between listing and LT on imaging | ||||||
| Decrease | 94 (52.5) | 7 (29.2) | 1.000 | 1.000 | ||
| Same | 20 (11.2) | 2 (8.3) | 1.243 (0.258-5.986) | 0.786 | 0.851 (0.153-4.738) | 0.854 |
| Increase | 65 (36.3) | 15 (62.5) | 3.097 (1.263-7.598) | 0.014 | 1.180 (0.392-3.554) | 0.768 |
| The trend of AFP between listing and LT | ||||||
| Decrease | 57 (29.1) | 4 (16.0) | 1.000 | |||
| Same | 94 (48.0) | 11 (44.0) | 1.697 (0.540-5.329) | 0.365 | ||
| Increase | 45 (23.0) | 10 (40.0) | 2.912 (0.913-9.284) | 0.071 | ||
| Size change between explant viable largest tumour and listing largest tumour | ||||||
| Decrease | 119 (57.5) | 7 (28.0) | 1.000 | |||
| Same | 22 (10.6) | 3 (12.0) | 2.090 (0.540-8.082) | 0.285 | ||
| Increase | 66 (31.9) | 15 (60.0) | 3.842 (1.566-9.424) | 0.003 | ||
| Explant viable tumour number | ||||||
| ≤ 3 | 152 (84.4) | 18 (75.0) | 1.000 | |||
| > 3 | 28 (15.6) | 6 (25.0) | 1.889 (0.750-4.759) | 0.177 | ||
| Microvascular invasion | 98 (46.9) | 21 (84.0) | 6.087 (2.089-17.735) | 0.001 | 3.014 (0.697-13.032) | 0.140 |
| Macrovascular invasion | 8 (3.8) | 6 (24.0) | 5.320 (2.121-13.348) | < 0.001 | 2.888 (0.907-9.198) | 0.073 |
| Satellite nodules | 11 (5.3) | 6 (24.0) | 4.728 (1.887-11.845) | 0.001 | 3.673 (1.204-11.210) | 0.022 |
| Tumor grade | ||||||
| Complete necrosis | 31 (15.0) | 1 (4.0) | 0.235 (0.032-1.736) | 0.156 | ||
| Well-differentiated | 48 (23.2) | 2 (8.0) | 0.311 (0.073-1.320) | 0.113 | ||
| Moderately differentiated | 112 (54.1) | 11 (44.0) | 0.673 (0.305-1.481) | 0.325 | ||
| Poorly differentiated | 16 (7.7) | 11 (44.0) | 7.805 (3.536-17.230) | < 0.001 | 3.727 (1.428-9.730) | 0.007 |
AFP: Alpha fetoprotein; DCD: Donation after circulatory death; DBD: Donation after brain stem death; RETREAT: Risk Estimation of Tumor Recurrence After Transplant; LT: Liver transplantation.