Nomogram of Agopian et al for Predicting Recurrence of Hepatocellular Carcinoma Following Liver Transplant

Description

Agopian et al developed a nomogram to identify patients with hepatocellular carcinoma who are likely to have a recurrence after liver transplant. This can help to evaluate patients pror to the procedure. The authors are from Dumont-UCLA Transplant and Liver Cancer Center and the University of California in Los Angeles.

Patient selection: hepatocellular carcinoma undergoing liver transplant

Parameters:

(1) nuclear grade

(2) vascular invasion

(3) downstaging

(4) radiologic maximum diameter

(5) serum AFP in ng/mL

(6) neutrophil-to-lymphocyte ratio (NLR)

(7) serum total cholesterol

neutrophil-to-lymphocyte ratio = NLR =

= (absolute neutrophil count) / (absolute lymphocyte count) =

= (percent neutrophils in differential count) / (percent lymphocytes)

NLR	Points
0 to 12	(-0.2938 * ((score)^2)) + (6.329 * (score)) + 1.452
12 to 56	(0.5286 * (ratio)) + 29.52
> 56	59

points for serum total cholesterol =

= MAX(0,MIN(53.3,(0.121136 * (serum cholesterol)) - 2.4227))

Serum AFP	Points
<= 20	(-0.006076 * ((AFP)^2)) + (0.592 * (AFP)) + 0.02616
20 to 70	(0.046 * (AFP)) + 8.48
70 to 290	(0.01091 * (AFP)) + 10.94
> 290	14.1

Parameter	Finding	Points
nuclear grade	well-differentiated	0
	moderately differentiated	43.4
	poorly differentiated	100
	unknown	21
vascular invasion	none	0
	microvascular	29
	macrovascular	95
downstaging	within Milan OR downstaged	0
	outside Milan and not downstaged	50
radiologic maximum diameter	incidental tumor	0
	nonincidental and < 5 cm	20
	nonincidental and >= 5 cm	46

total score =

= SUM(points for all 7 parameters)

Interpretation:

• minimum score: 0

• maximum:

• The higher the score the greater the risk of recurrence.

Points	5-Year Recurrence Rate
< 37	< 3%
37 to 180	(0.002499 * ((score)^2)) - (0.2294 * (score)) + 9.044
180 to 268	(-0.004718 * ((score)^2)) + (2.69 * (score)) - 282.6
> 268	> 99%

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Description

Specialty

ICD-10