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Sarkar et al. Predictors of survival in HCC treatment

therapy of the tumor recurrence, and had survival hepatologists, oncologists and interventional
comparable to those without recurrence. These radiologists are closely associated, so multidisciplinary
differences support our hypothesis that careful patient management allowed equal access to all treatment
selection, based on characteristics that predict a low modalities. Finally, this study was conducted in a
level of hepatic parenchyma fibrosis and preserved small state with a high burden of HCC and has long
synthetic function, can identify patients who will term follow-up of both transplant and non-transplant
have a good long-term outcome after non-transplant patients.
therapies.
In conclusion, this study suggests that patients
Although APRI is not widely used in liver transplant with single HCC tumors ≤ 3 cm, with an APRI
literature, we propose that this can be a helpful ≤ 0.5 and MELD score < 10, have an OS after
tool. Liver function can be inferred by prognostic resection or ablation similar to patients undergoing
scores such as CTP, MELD or functional tests such transplantation. Recurrences are higher in this group
as Indocyanine Green. Degree of fibrosis can be than patients who underwent transplantation, however
assessed more directly by measuring hepatic vein recurrences tended to occur late (> 2 years). While
pressures, liver biopsy or transient elastography. liver transplantation remains the optimal treatment for
These tests are often limited by operator-dependence, HCC, perhaps this subset of patients can safely wait
biopsy interpretation, sample error, body habitus, and until a more urgent reason for transplant arises, in
invasiveness. Prognostic scores have been predictive areas where donor livers are limited. Future studies
of short-term outcome and survival on a transplant list validating this in a larger population could assist
but these scores were not used specifically to assess in directing patients with good prognosis to non-
fibrosis, longer-term prognosis or predisposition for transplant therapies, and allow allocation of scarce
recurrent cancer. APRI is easy to calculate at the donor livers to patients with a greater need.
bedside with readily available laboratory parameters
and does not require an expensive or invasive test. Authors’ contributions
We found that while an APRI ≤ 0.5 was correlated with Concept/design, data acquisition, critical revision: L.L.
a statistically significant OR for both 3-year and 5-year Wong
OS in the HR, RFA, and composite HR/RFA groups, Manuscript preparation, data analysis: J. Sarkar
an APRI ≤ 1.00 did not predict a survival advantage. Data analysis: T. DeLeon
APRI is a reasonable surrogate for fibrosis and our
study has shown that when used with MELD < 10, this Financial support and sponsorship
has prognostic significance.
This paper was supported by NIH2 P30 CA071789-
13.
This study is limited by its retrospective nature and
relatively small sample size. Due to the small sample Conflicts of interest
size, we were unable to report on the outcomes
following other non-transplant treatments such as There are no conflicts of interest.
TACE and Yttrium-90. It will be necessary to validate
these results in a larger prospective study. This Patient consent
analysis also reported only overall survival, as some As this was a retrospective study, the IRB did not
patients had recurrence of HCC that was treated require patient consent.
but died of liver failure or an unrelated problem. It is
thus difficult to determine the exact effect of HCC on Ethics approval
survival. Because it was a retrospective study, we did This study received IRB approval at the University of
not account for patient comorbidities that may have Hawaii.
affected candidacy for transplant or overall survival.
This is evident by the older age of the patients who REFERENCES
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84 Hepatoma Research ¦ Volume 3 ¦ May 09, 2017