Functional performance as measured by the Karnofsky Performance Status (KPS) scale has been linked to the outcomes of liver transplant patients; however, the effect of KPS on the outcomes of the hepatocellular carcinoma (HCC) liver transplant population has not been fully elucidated. We aimed to investigate the association between pre-transplant KPS score and long-term outcomes in HCC patients listed for liver transplantation. Adult HCC candidates listed on the Scientific Registry of Transplant Recipients (SRTR) database from January 1, 2011 to December 31, 2017 were grouped into group I (KPS 80–100%, n = 8,379), group II (KPS 50–70%, n = 8,091), and group III (KPS 10–40%, n = 1,256) based on percentage KPS score at listing. Survival was compared and multivariable analysis was performed to identify independent predictors. Patients with low KPS score had a higher risk of removal from the waiting list. The 5-year intent-to-treat survival was 57.7% in group I, 53.2% in group II and 46.7% in group III (P < 0.001). The corresponding overall survival was 77.6%, 73.7% and 66.3% in three groups, respectively (P < 0.001). Multivariable analysis demonstrated that KPS was an independent predictor of intent-to-treat survival (P < 0.001, reference group I; HR 1.19 [95%CI 1.07–1.31] for group II, P = 0.001; HR 1.63 [95%CI 1.34–1.99] for group III, P < 0.001) and overall survival(P < 0.001, reference group I; HR 1.16 [95%CI 1.05–1.28] for group II, P = 0.004; HR 1.53 [95%CI 1.26–1.87] for group III, P < 0.001). The cumulative 5-year recurrence rates was higher in group III patients (7.4%), compared with 5.2% in group I and 5.5% in group II (P = 0.037). However, this was not significant in the competing regression analysis. Low pre-transplant KPS score is associated with inferior long-term survival in liver transplant HCC patients, but is not significantly associated with post-transplant tumor recurrence.

中文翻译：

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卡氏体能状态对肝移植肝癌患者预后的影响

通过卡诺夫斯基功能状态（KPS）量表测量的功能表现与肝移植患者的结果相关；然而，KPS 对肝细胞癌 (HCC) 肝移植人群结局的影响尚未完全阐明。我们的目的是调查移植前 KPS 评分与列入肝移植的 HCC 患者的长期结局之间的关联。2011年1月1日至2017年12月31日期间在移植受者科学登记处（SRTR）数据库中列出的成年 HCC 候选者被分为第一组（KPS 80–100%，n = 8,379）、第二组（KPS 50–70%） ，n = 8,091）和第三组（KPS 10–40%，n = 1,256）基于上市时的 KPS 分数百分比。比较生存率并进行多变量分析以确定独立的预测因子。KPS 评分较低的患者从候补名单中删除的风险较高。I 组的 5 年意向治疗生存率为 57.7%，II 组为 53.2%，III 组为 46.7%（P < 0.001）。三组相应的总生存率分别为77.6%、73.7%和66.3%（P < 0.001）。多变量分析表明，KPS 是意向治疗生存期的独立预测因子（P < 0.001，参考组 I；HR 1.19 [95%CI 1.07–1.31]，组 II，P = 0.001；HR 1.63 [95%CI 1.34] –1.99] 对于第 III 组，P < 0.001）和总生存率（P < 0.001，参考组 I；HR 1.16 [95% CI 1.05–1.28] 对于第 II 组，P = 0.004；HR 1.53 [95% CI 1.26–1.87] ] 对于第 III 组，P < 0.001）。III组患者的累积5年复发率较高（7.4%），而I组患者为5.2%，II组患者为5.5%（P = 0.037）。然而，这在竞争回归分析中并不显着。移植前低 KPS 评分与肝移植 HCC 患者的长期生存较差相关，但与移植后肿瘤复发没有显着相关。