Halazun et al developed the MORAL (Model Of Recurrence After Liver transplant) scores for evaluating a patient undergoing liver transplantation for hepatocellular carcinoma. The authors are from Weill Cornell Medical College and Columbia, University in New York City.
Patient selection: liver transplant for hepatocellular carcinoma
Parameters:
(1) preoperative neutrophil to lymphocyte ratio (NTR)
(2) maximum serum AFP in ng/mL
(3) diameter of largest tumor in preoperative imaging in centimeters
(4) histologic Grade
(5) vascular invasion
(6) largest tumor diameter on pathology in centimeters
(7) tumor number on pathologic exam
neutrophil to lymphocyte ratio =
= (neutrophil count) / (lymphocyte count)
|
Parameter
|
Finding
|
Points
|
|
preop NTR
|
< 5
|
0
|
|
|
>= 5
|
6
|
|
maximum AFP
|
<= 200 ng/mL
|
0
|
|
|
> 200 ng/mL
|
4
|
|
largest diameter
|
<= 3 cm
|
0
|
|
|
> 3 cm
|
3
|
pre-MORAL score =
= SUM(points for all 3 parameters
|
Parameter
|
Finding
|
Points
|
|
histologic Grade
|
1 to 3
|
0
|
|
|
4
|
6
|
|
vascular invasion
|
no
|
0
|
|
|
yes
|
2
|
|
largest size
|
<= 3 cm
|
0
|
|
|
> 3 cm
|
3
|
|
tumor number
|
<= 3
|
0
|
|
|
> 3 cm
|
2
|
post-MORAL score =
= SUM(points for all 4 parameters)
combined score =
= (pre-MORAL score) + (post-MORAL score)
Interpretation:
• minimum scores: 0
• maximum pre-MORAL score: 13
• maximum post-MORAL score: 13
• maximum combined score: 26
|
Total Score
|
Recurrence Risk
|
|
0 to 2
|
low
|
|
3 to 6
|
medium
|
|
7 to 10
|
high
|
|
>= 11
|
very high
|
Performance:
• The area under the ROC curve was 0.82 for pre-MORAL score, 0.88 for post-MORAL score, and 0.91 for the combined score.
