Metroticket 2.0 calculator

Clinical inputs

• Alpha-fetoprotein (ng/mL)Accepted range: 0.1 to 1000000
• Number of vital nodulesAccepted range: 0 to 40
• Largest vital nodule (cm)Accepted range: 0 to 30
• Hepatitis C

Primary source

Mazzaferro V et al. Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma. Gastroenterology. DOI: 10.1053/j.gastro.2017.09.025. PMID: 28989060. Table 3 mean competing-risk coefficients for hepatocellular-carcinoma death are 0.817 for log10 alpha-fetoprotein in ng/mL and 0.227 for the number of vital nodules plus the diameter of the largest vital nodule in cm. Mean baseline cumulative sub-hazard is 0.003 at 1 year, 0.011 at 3 years, and 0.014 at 5 years. Five-year cumulative incidence is 1 − exp(−0.014 × exp(0.817 × log10 alpha-fetoprotein + 0.227 × number-plus-size)). The reported score is 5-year hepatocellular-carcinoma-specific survival, 100 minus that incidence. Figure 2 prints a flat 5-year cumulative incidence of death from other causes of 8.6% when hepatitis C is absent and 18.1% when hepatitis C is present, and that incidence is added to the hepatocellular-carcinoma incidence for overall 5-year risk. Alpha-fetoprotein-adjusted size criteria are sum at most 7 when alpha-fetoprotein is under 200 ng/mL, at most 5 from 200 up to but not including 400 ng/mL, and at most 4 from 400 through 1000 ng/mL. A value of 400 ng/mL is placed with the 400–1000 rule. The result states that a 70% chance of 5-year hepatocellular-carcinoma-specific survival was the survival level discussed with those criteria. (2018)