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Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria.

Christophe Duvoux 1, 2, * Françoise Roudot-Thoraval 1, 3 Thomas Decaens 1, 2 Fabienne Pessione 4 Hanaa Badran 2 Tullio Piardi 5 Claire Francoz 6 Philippe Compagnon 7 Claire Vanlemmens 8 Jérome Dumortier 9 Sébastien Dharancy 10 Jean Gugenheim 11 Pierre-Henri Bernard 12 René Adam 13 Sylvie Radenne 14 Fabrice Muscari 15 Filomena Conti 16 Jean Hardwigsen 17 Georges-Philippe Pageaux 18 Olivier Chazouillères 16 Ephrem Salame 19 Marie-Noelle Hilleret 20 Pascal Lebray 21 Armand Abergel 22 Marilyne Debette-Gratien 23 Michael D. Kluger 24 Ariane Mallat 1, 2 Daniel Azoulay 2, 24 Daniel Cherqui 2, 24 
Abstract : 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.
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Submitted on : Tuesday, September 24, 2013 - 2:09:00 PM
Last modification on : Saturday, May 21, 2022 - 3:21:49 AM



Christophe Duvoux, Françoise Roudot-Thoraval, Thomas Decaens, Fabienne Pessione, Hanaa Badran, et al.. Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria.. Gastroenterology, WB Saunders, 2012, 143 (4), pp.986-94.e3; quiz e14-5. ⟨10.1053/j.gastro.2012.05.052⟩. ⟨inserm-00865368⟩



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