Evidence map›Paper›PMID 26779979›Full record

ArticleAnnals of surgery2016

Serum Tumor Markers Provide Refined Prognostication in Selecting Liver Transplantation Candidate for Hepatocellular Carcinoma Patients Beyond the Milan Criteria.

Jeong-Hoon Lee, Yuri Cho, Hwi Young Kim, Eun Ju Cho, Dong Hyeon Lee, Su Jong Yu, Jae Woo Lee, Nam-Joon Yi, Kwang-Woong Lee, Seoung Hoon Kim and 7 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Annals of surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 72 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
72citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

72 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  15. Long-Term Prognostic Value of AFP and PIVKA-II in HCC After Living Donor Liver Transplantation: A Single-Center Retrospective Study.Transplant international : official journal of the European Society for Organ Transplantation · 2025
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12 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Jeong-Hoon Lee*Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea †Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea ‡Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea ¶Department of Surgery, Seoul National University College of Medicine, Seoul, Korea §Center for Liver Cancer, National Cancer Center, Goyang-Si, Gyeonggi-Do, Korea ||Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea **Mary Lea Johnson Richards Organ Transplantation Center, New York University Langone Medical Center, New York, NY.
Yuri Cho
Hwi Young Kim
Eun Ju Cho
Dong Hyeon Lee
Su Jong Yu
Jae Woo Lee
Nam-Joon Yi
Kwang-Woong Lee
Seoung Hoon Kim
Jong Man Kim
Jae-Won Joh
Lewis W Teperman
James S Park
Yoon Jun Kim
Kyung-Suk Suh
Jung-Hwan Yoon

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo develop and validate a model to predict tumor recurrence after living donor liver transplantation (LDLT) (MoRAL) for hepatocellular carcinoma (HCC) beyond the Milan criteria (MC).

backgroundSome subgroups of HCC exceeding the MC experience substantial benefit from LDLT.

methodsThis multicenter study included a total of 566 consecutive patients who underwent LDLT in Korea: the beyond-MC cohort (n = 205, the derivation [n = 92] and validation [n = 113] sets) and the within-MC cohort (n = 361). The primary endpoint was time-to-recurrence.

resultsUsing multivariate Cox proportional hazard model, we derived the MoRAL score using serum levels of protein induced by vitamin K absence-II and alpha-fetoprotein, which provided a good discriminant function on time-to-recurrence (concordance index = 0.88). Concordance index was maintained similarly on both internal and external validations (mean 0.87 and 0.84, respectively). At cut off of 314.8 (75th percentile value), a low MoRAL score (≤314.8) was associated with significantly longer recurrence-free (versus > 314.8, HR = 5.29, P < 0.001) and overall survivals (HR = 2.59, P = 0.001) in the beyond-MC cohort. The 5-year recurrence-free and overall survival rates of beyond-MC patients with a low MoRAL score were as high as 66.3% and 82.6%, respectively. The within-MC patients with a high MoRAL score showed a higher risk of recurrence than beyond-MC patients with a low MoRAL score (HR = 2.56, P = 0.035). The MoRAL score was significantly correlated with explant histology.

conclusionsThis new model using protein induced by vitamin K absence-II and alpha-fetoprotein provides refined prognostication. Among beyond-MC HCC patients, those with a MoRAL score ≤314.8 and without extrahepatic metastasis might be potential candidates for LDLT.

Indexed as

Liver TransplantationPatient SelectionAdultAgedBiomarkersCarcinoma, HepatocellularDiagnostic ImagingFemaleHumansLiver NeoplasmsMaleMiddle AgedNeoplasm Recurrence, LocalPredictive Value of TestsPrognosisRepublic of KoreaBiomarkers

Identifiers

PMID26779979

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.