Zhang, XFXue, FBagante, FRatti, FMarques, HPSilva, SSoubrane, OLam, VPoultsides, GAPopescu, IGrigorie, RAlexandrescu, SMartel, GWorkneh, AGuglielmi, AHugh, TAldrighetti, LLv, YPawlik, TM2023-04-132023-04-132022J Gastrointest Surg . 2022 May;26(5):1021-1029http://hdl.handle.net/10400.17/4489Objectives: To identify the preoperative risk factors for prediction of non-transplantable recurrence (NTR) after tumor resection for early-stage hepatocellular carcinoma (HCC) to assist in patient selection relative to upfront liver resection (LR) versus liver transplantation (LT). Methods: Patients who underwent curative resection for transplantable HCC and chronic liver disease were identified from an international multi-institutional database. NTR was defined as recurrence beyond the Milan or UCSF criteria, and the preoperative risk factors of NTR were investigated. Results: Among 293 patients with transplantable HCC within Milan criteria and 320 within UCSF criteria, 113 (38.6%) and 131 (40.9%) patients developed tumor recurrence, respectively. Among patients who recurred, NTR was present in 32 (28.3%) patients within Milan and 35 (26.7%) within UCSF criteria. When either Milan or UCSF criteria was adopted, three preoperative risk factors including liver cirrhosis, tumor size > 3 cm, and multiple lesions were consistently identified as risk factors associated with NTR after curative resection. By summing up the three factors, a scoring model was established and the incidence of NTR among patients with 0, 1 or ≥ 2 risk factors incrementally increased from 4.5%, 13.3% to 20.5% when Milan criteria was used, and from 4.5%, 12.4% to 33.9% when UCSF criteria was adopted. The model demonstrated very good discriminatory power on internal validation (n = 5,000) (c-index 0.689 for Milan criteria, and 0.715 for UCSF criteria). Conclusions: Whereas surgical resection may be optimal first-line treatment for patients with no or one risk factor, patients with ≥ 2 risk factors should be considered for upfront liver transplantationengCarcinoma, Hepatocellular* / pathologyCarcinoma, Hepatocellular* / pathologyHepatectomyLiver Neoplasms* / pathologyLiver Neoplasms* / surgeryLiver Neoplasms* / surgeryPatient SelectionRetrospective StudiesTreatment OutcomeHCC CIRjournal article10.1007/s11605-021-05206-8