Background: Recurrence prediction models for hepatocellular carcinoma liver transplantation in western countries already exist, but the differences in tumor biological characteristics among different populations. So we aim to create a Nomogram prediction model for predicting hepatocellular carcinoma liver transplantation patients in China to predict individual survival after surgery and guide the postoperative treatment.
Materials and Methods: Between February 2016 and October 2019, 210 HCC patients who received liver transplantation in the Huashan Hospital Affiliated to Fudan University were collected for this study. Prognostic nomograms predicting post-transplant recurrence were developed from a multivariate cox regression. The prediction power of the nomograms was tested by C-statistic and calibration plots.
Results: There were 46(21.9%) patients within the Milan criteria. Before transplantation,24(11.4%) patients received transcatheter arterial chemoembolization (TACE) and 9(4.3%) received tumor targeted therapy.Multivariate predictors of recurrence included Age,Max diameter,thrombus,MVI,ALT on the 7th day after surgery(7d-ALT),AFP on the 7th day after surgery(7d-AFP). Nomogram for recurrence free survival (RFS) have been created. Discrimination and calibration of the nomograms revealed good predictive abilities(C-index:0.796).

Compared with Milan criteria(C-index:0.617), UCSF criteria(C-index:0.624), the RFS nomogram improved accuracy in predicting recurrence after transplantation for HCC.
Finally, two subgroups were generated based on the total risk points . The 1,2,3-year recurrence rate were 16.6%,23.3%,26.9%for the low risk group,and 52.4%,80.1%,80.1% for the high risk group, respectively.

Conclusion: The nomogram made by using different examination indexes had good ability in predicting prognostic recurrence and guiding the follow-up of patients.It can achieve patient stratification and guide patients for treatment and follow-up.Patients with score above 312.1 points had high risk of early recurrenceafter LT.For these patients, more strict postoperative targeted treatment and follow-up are needed.
In order to be convenient and practical, we have also made web prediction models for convenience and practicality.For example, a 45 year old male (0 point), tumor maximum diameter of 7cm (30.3 points), have tumor thrombus (78.8 point), MVI of 1 (36.9 points), ALT of 156u / L (25.1 points), AFP of 83 μ g / L (6.2 points) on the 7th day after operation. For this example, the total score is 177.3 points, so the predicted recurrence rate of 1 and 2 years is 18% and 31%. This calculated value can be used to develop treatment plans and communicate with patients.

https://maensi.shinyapps.io/Huashan_surgery/