Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria.
- Creators
- Duvoux, Christophe
- Roudot-Thoraval, Françoise
- Decaens, Thomas
- Pessione, Fabienne
- Badran, Hanaa
- Piardi, Tullio
- Francoz, Claire
- Compagnon, Philippe
- Vanlemmens, Claire
- Dumortier, Jérome
- Dharancy, Sébastien
- Gugenheim, Jean
- Bernard, Pierre-Henri
- Adam, René
- Radenne, Sylvie
- Muscari, Fabrice
- Conti, Filomena
- Hardwigsen, Jean
- Pageaux, Georges-Philippe
- Chazouillères, Olivier
- Salame, Ephrem
- Hilleret, Marie-Noelle
- Lebray, Pascal
- Abergel, Armand
- Debette-Gratien, Marilyne
- Kluger, Michael
- Mallat, Ariane
- Azoulay, Daniel
- Cherqui, Daniel
- Others:
- Institut Mondor de Recherche Biomédicale (IMRB) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)
- Pôle Recherche Clinique-Santé Publique [Mondor] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor
- Service de santé publique [Mondor] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)
- Pôle évaluation - biostatistique ; Agence de la biomédecine [Saint-Denis la Plaine]
- Service de Transplantation ; Hôpital de Hautepierre [Strasbourg]
- Service d'hépatologie ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
- Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes] ; CHU Pontchaillou [Rennes]
- Service d'hépatologie ; Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC) ; Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)
- service d'Hépato-gastro-entérologie ; Hospices Civiles de Lyon-Hôpital Edouard Heriault
- Service d'hépatologie ; Hôpital Claude Hurriez
- Centre méditerranéen de médecine moléculaire (C3M) ; Université Nice Sophia Antipolis (1965 - 2019) (UNS) ; COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA)
- Service d'Hépato-Gastro-Entérologie ; CHU Bordeaux [Bordeaux]-Hôpital Saint-André
- Centre hépato-biliaire (CHB) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Service d'hépatologie ; Hospices Civils de Lyon (HCL)-Hôpital de la Croix-Rousse [CHU - HCL] ; Hospices Civils de Lyon (HCL)
- Chirurgie Générale et Digestive [Rangueil] ; Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)
- CHU Saint-Antoine [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
- Service de Chirurgie ; Assistance Publique - Hôpitaux de Marseille (APHM)-Hospices Civiles de Marseille-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION)
- Service d'hépatologie ; Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier) ; Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
- Département de Chirurgie [CHU Caen] ; Université de Caen Normandie (UNICAEN) ; Normandie Université (NU)-Normandie Université (NU)-CHU Caen ; Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)
- Département de Gastroentérologie et hépatologie ; Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon
- CHU Pitié-Salpêtrière [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
- Service d'hépatologie ; CHU Etaing
- Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges] ; CHU Limoges
- Service de Chirurgie ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor
Description
BACKGROUND & AIMS: The aim of this study was to generate an improved prognostic model for predicting recurrence in liver transplant candidates with hepatocellular carcinoma (HCC). METHODS: Predictors of recurrence were tested by a Cox model analysis in a training cohort of 537 patients transplanted for HCC. A prognostic score was developed and validated in a national cohort of 435 patients followed up prospectively. RESULTS: α-Fetoprotein (AFP) independently predicted tumor recurrence and correlated with vascular invasion and differentiation. At a Cox score threshold of 0.7 (area under the receiver operating characteristic curve, 0.701; 95% confidence interval, 0.63-0.76; accuracy, 75.8%), a model combining log(10) AFP, tumor size, and number was highly predictive of tumor recurrence and death. By using a simplified version of the model, with untransformed AFP values, a cut-off value of 2 was identified. In the validation cohort, a score greater than 2 predicted a marked increase in 5-year risk of recurrence (50.6% ± 10.2% vs 8.8% ± 1.7%; P < .001) and decreased survival (47.5% ± 8.1% vs 67.8% ± 3.4%; P = .002) as compared with others. Among patients exceeding Milan criteria, a score of 2 or lower identified a subgroup of patients with AFP levels less than 100 ng/mL with a low 5-year risk of recurrence (14.4% ± 5.3% vs 47.6% ± 11.1%; P = .006). Among patients within Milan criteria, a score greater than 2 identified a subgroup of patients with AFP levels greater than 1000 ng/mL at high risk of recurrence (37.1% ± 8.9% vs 13.3% ± 2.0%; P < .001). Net reclassification improvement showed that predictability of the AFP model was superior to Milan criteria. CONCLUSIONS: Prediction of tumor recurrence is improved significantly by a model that incorporates AFP. We propose the adoption of new selection criteria for HCC transplant candidates, taking into account AFP.
Abstract
International audience
Additional details
- URL
- https://inserm.hal.science/inserm-00865368
- URN
- urn:oai:HAL:inserm-00865368v1
- Origin repository
- UNICA