Biases in the reporting of hcc tumor sizes on the liver transplant waiting list

Abstract

We investigate the possibility that patients with hepatocellular carcinoma (HCC) listed for liver transplant with tumors just outside Stage T2 size criteria may be inaccurately reported as just meeting the tumor size criteria for transplant. The UNOS/STAR database identified 12,958 patients listed for liver transplants with HCC exception points from 2006-2013, 9,168 of whom were listed with one tumor. A logistic power peak function was fitted to the single-tumor size histogram, with the fitted values representing unbiased expected values. The difference between the observed and expected tumor counts for 2.0cm and 5.0cm was 238 (22%) and 66 (57%), respectively. This suggests that up to 304 (3.0%) patients with tumors outside of transplant criteria had their measurements recorded at the margins of eligibility. A risk-adjusted Poisson model evaluated the ratio of observed to expected (O:E) HCC recurrence by tumor size. There were 435 HCC recurrences among 6,049 transplants. Only 2.0cm tumors had O:E recurrence differing from 1 (ratio 0.73, 95%CI 0.57-0.94), indicating a 27% lower than expected rate of recurrence. Conclusion: Higher than expected observed tumor counts at the lower transplant criteria margin were corroborated by lower than expected HCC recurrence, suggesting that tumor sizes at the margins of HCC transplant criteria may be subject to inaccurate reporting. This article is protected by copyright. All rights reserved.

http://ift.tt/2pOPDVB