Validation of the "Metroticket" predictor in a cohort of patients transplanted for predominantly HBV-related hepatocellular carcinoma

Abstract

Background & aims: The "Metroticket" prognostic model for survival post liver transplant for hepatocellular carcinoma (HCC) was developed from a European cohort of patients with predominantly alcoholic liver disease and hepatitis C-related HCC. The aim of this study was to evaluate the prognostic value of the Metroticket in an independent cohort of patients with predominantly HBV-related HCC, in an Asia-Pacific transplant programme.

Methods: All patients listed for HCC at the New Zealand Liver Transplant Unit (NZLTU) between January 1998 and November 2009 were included. For each patient, the predicted 3 and 5 year post-transplant survival score was calculated using the Metroticket model (http://www.hcc-oltmetroticket.org/calculator/index.php). The observed and predicted survivals were compared.

Results: Ninety-five patients with HCC were listed, 82 were transplanted (40 with HBV) and 13 delisted for progression. Predicted survival calculated by the Metroticket model based on pre-transplant radiological data (n = 82) was 76.3% and 69.7% at 3 and 5 years, respectively, while the observed survival was 83% (49/59) and 74% (35/47), respectively. Of the 40 patients with HBV, observed survivals were 84% (26/31) and 80% (20/25) at 3 and 5 years, compared with 80% (23/28) and 69.6% (16/23), respectively, for the 42 patients without HBV. On intent to treat analysis, survival after listing was 73.8% (95% CI 62.7-82.1) at 3 years and 69.1% (53.7-78.2%) at 5 years. AFP level was associated with vascular invasion.

Conclusions: The Metroticket calculator incorporating pre-transplant radiological Staging was an accurate predictor of post-transplant survival in a cohort of predominantly HBV-related HCC.