Pretransplant recurrent liver cancer prediction score (p-RELAPSE) to risk stratify hepatocellular carcinoma patients undergoing liver transplantation: validation in an international multicenter retrospective cohort
Year: 2026
Type: article
Abstract: Background: Selection of patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) increasingly integrates dynamic tumor biology alongside morphometric criteria. Methods: We developed and externally validated the pre-transplant REcurrent Liver cAncer Prediction ScorE (p-RELAPSE) to predict post-LT recurrence using two retrospective cohorts. Post-LT outcomes of 4420 HCC patients undergoing LT in the US Multicenter HCC Transplant Consortium (UMHTC) were analyzed to derive p-RELAPSE using a competing risks multivariable model, with external validation in 1736 HCC LT recipients from the European Hepatocellular Cancer Liver Transplant (EurHeCaLT) group. Results: The UMHTC training ( n = 2893), internal validation ( n = 1527), and EurHeCaLT ( n = 1736) cohorts showed comparable 5-year overall survival (69.4–71.0%), recurrence-free survival (66.2–66.3%), and recurrence incidence (12.6–14.4%; all P > 0.05). p-RELAPSE incorporated Milan criteria (MC) status, downstaging, maximum tumor diameter, dynamic alpha-fetoprotein (AFP) response, and waitlist time. The model stratified recurrence risk even within MC patients. In EurHeCaLT, p-RELAPSE achieved a C-statistic of 0.69, outperforming MC, French AFP, Up-to-7, pre-MORAL, and New York/California models ( P < 0.05). Conclusions: By integrating AFP dynamics and waitlist time, p-RELAPSE refines post-LT recurrence risk stratification, identifying MC patients unlikely to benefit from LT and non-MC patients with favorable outcomes. This externally validated model provides a robust framework for individualized pre-LT decision-making in HCC candidates.
Source: International Journal of Surgery
Authors: Benjamin V. Tran, Dominic Amara, Andrew Melehy, Dimitrios Moris, Daniela Markovic, Quirino Lai, Jan Lerut, Hamed Zaribafzadeh, Ricardo Henao, Sander S. Florman, Parissa Tabrizian, Richard M. Ruiz, Goran B. Klintmalm, David D. Lee, C. Burcin Taner, Maarouf Hoteit, Umberto Cillo, Alessandro Vitale, Elizabeth C. Verna, Karim J. Halazun, Amit D. Tevar, Abhinav Humar, William C. Chapman, Neeta Vachharajani, Federico Aucejo, Olga Ciccarelli, Mindie H. Nguyen, Marc L. Melcher, Benedikt Schaefer, Maria Hoppe-Lotichius, Guiseppe M. Ettorre, Emmanuel A. Tsochatzis, Trevor L. Nydam, James F. Markmann, Massimo Rossi, Constance Mobley, Mark Ghobrial, Tommaso M. Manzia, Alan N. Langnas, Carol A. Carney, Jennifer Berumen, Gabriel T. Schnickel, Marco Vivarelli, Salvatore Agnes, Debra L. Sudan, Johnny C. Hong, Abbas Rana, Christopher M. Jones, Thomas M. Fishbein, Andrew S. Barbas, Vatche G. Agopian
Institutions: University of California, Los Angeles, Duke Medical Center, Policlinico Umberto I, Sapienza University of Rome, UCLouvain, Duke University, Mount Sinai Hospital, Baylor University Medical Center, Beth Israel Deaconess Medical Center, Mayo Clinic in Florida, University of Pennsylvania, University of Padua, NewYork–Presbyterian Hospital, Columbia University, NYU Langone Health, New York University, University of Pittsburgh Medical Center, Washington University in St. Louis, Cleveland Clinic, Stanford University, Innsbruck Medical University, Universität Innsbruck, University Medical Center of the Johannes Gutenberg University Mainz, Azienda Ospedaliera San Camillo-Forlanini, The Royal Free Hospital, University College London, University of Colorado Anschutz, University of Colorado Denver, Harvard University, Massachusetts General Hospital, Houston Methodist, University of Rome Tor Vergata, University of Nebraska Medical Center, University of California San Diego, Marche Polytechnic University, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Pennsylvania State University, Penn State Milton S. Hershey Medical Center, Baylor College of Medicine, University of Louisville, Georgetown University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W7225773629