Novel tool predicts postoperative liver cancer recurrence after transplant

A novel method has been developed to more accurately calculate the risk of disease recurrence in liver cancer patients who have undergone a liver transplant. This provides a new tool to help make treatment and surveillance decisions.

This study was presented by Ronald W. Busuttil, MD, PhD, of the University of California Los Angeles (UCLA) at the 126th Annual Meeting of the Southern Surgical Association and published in the Journal of the American College of Surgeons (2014; doi:10.1016/j.jamcollsurg.2014.12.025).

The predictive calculator, also known as a nomogram, was developed after the research team analyzed data from UCLA's 30 years of experience with liver transplantation for liver cancer. The retrospective study included 865 patients with liver cancer who received transplants between 1984 and 2013, said study first author Vatche G. Agopian, MD, also of UCLA.

Prior to 1996, there were no criteria to guide which patients with liver cancer might be good candidates for transplant, and patients with all sizes and numbers of tumors underwent transplantation, often with early recurrence of disease. In 1996, radiologic criteria popularized as the Milan criteria were introduced and recommended limiting transplantation to patients with a single tumor of 5 cm or less or up to three tumors with not any single tumor larger than 3 cm.

However, the criteria did not take into account the aggressiveness of the tumor or other blood biomarkers that can help predict recurrence, Agopian said. UCLA's nomogram used three groups of factors to predict recurrence and was more accurate than the Milan criteria and the existing American Joint Committee on Cancer pathologic TNM staging system, giving transplant physicians and oncologists more information to work with in deciding how often to monitor for recurrence and whether or not adjuvant treatment is necessary.

"This novel nomogram includes three important groups of information that proved to be very accurate in predicting recurrence in liver cancer patients, better than any other system out there," Agopian said. "Physicians can use our nomogram and have a meaningful discussion with transplant recipients regarding their posttransplant risk of cancer recurrence. It can help them decide how closely to follow their patient, as a patient with a low risk of recurrence may not need screening as often, or whether a patient with a high risk of recurrence might need treatment following the transplant."

The three groups of factors that comprise the UCLA nomogram include pretransplant radiologic information or the number and size of tumors on MRI and CT scans, three pretransplant blood biomarkers thought to be predictive for cancer recurrence and pathologic characteristics of the explanted liver. The diseased liver is studied to determine the grade, or aggressiveness, of the tumor and whether the cancer has invaded the liver's blood vessels, factors that cannot be determined before transplant.

"In the largest single-institution experience with liver transplant for liver cancer, excellent long-term survival was achieved. Incorporation of routine pretransplant biomarkers to existing radiographic size criteria significantly improves the ability to predict posttransplant recurrence, and should be considered in recipient selection," the study stated. "A novel clinicopathologic prognostic nomogram accurately predicts liver cancer recurrence after liver transplant and may guide frequency of posttransplant surveillance and adjuvant therapy."

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