Wisel, Steven A.

Background: Hepatocellular carcinoma (HCC) has a poor long-term prognosis due to high recurrence and cirrhosis-related mortality, even after potentially curative treatments such as liver transplantation (LT), surgical resection, or ablation. This study aimed to identify factors associated with ≥10-year survival in HCC patients. Methods: A retrospective cohort study was conducted among HCC patients diagnosed between 2004 and 2022 using the National Cancer Database. Multivariable Cox regression was used to identify predictors of overall survival, and logistic regression was used to identify predictors of ≥10-year survival. Results: Among 249,600 HCC patients, 177,585 (71.2%) died within 5 years, 8613 (3.5%) died at 5–10 years, 54,988 (22.0%) were alive with <10 years of follow-up, and 8219 (3.3%) survived ≥10 years. LT, resection, and ablation were performed in 6.6%, 9.3%, and 11% of patients, respectively. Compared with ablation as the reference group, LT [adjusted odds ratio (aOR) 11.96, 95% confidence interval (CI): 11.27–13.29] and resection (aOR: 2.83, 95% CI: 2.57–3.08) increased the odds of ≥10-year survival, while non-curative treatments reduced the odds compared with ablation (aOR: 0.50, 95% CI: 0.47–0.55). Cox regression results were consistent with the logistic model, confirming the association. Decision tree analysis confirmed LT as the dominant determinant of long-term survival. Black individuals were associated with lower odds of ≥10-year survival (aOR: 0.88, 95% CI: 0.820–0.96) and decreased likelihood of receiving LT (aOR: 0.73, 95% CI: 0.55–0.96). Conclusions: LT offers the best chance of ≥10-year survival in HCC. Ensuring equitable access is essential, especially for Black patients who have lower transplant rates and worse outcomes.

Background. Assessment tools in surgical education help identify improvement areas for trainees. We developed and present validity evidence for a novel Transplant Operative Assessment Tool to optimize technical feedback for surgical trainees in transplantation. Methods. The Transplant Operative Assessment Tool assesses learners on anatomy, technical skills, judgment, and communication. Performance is rated across 5 competency levels. Content validity evidence included a construct map using existing literature and expert cognitive interviews. Ratings were used to develop an item response theory calibration, which was then used to evaluate the tool and provide validity evidence. Results. Eighty-two assessments for 28 trainees (16 residents, 12 fellows) were completed by 25 faculty surgeons across 4 programs. Fifty-six kidney transplants, 13 liver transplants, and 13 donor nephrectomies were assessed. The mean assessment completion time was 4.1 ± 4.3 min. Internal structure validity was evaluated by calculating item infit (range, 0.86–1.15), indicating a strong model fit and confirming a high quality of items. Internal consistency was also high (Cronbach’s alpha = 0.94). There was a positive correlation between ratings and training level ( P < 0.01), indicating strong discriminatory power. Warm ischemia time for transplant operations did not correlate with performance ( P = 0.16). Conclusions. These data provide validity evidence for a novel operative assessment tool. This instrument can measure performance, monitor progress, document competency, and has the potential to provide valuable feedback.