R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation.

Autor:	Costentin C; Grenoble Alpes University, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Grenoble, France.; Gastroenterology, Hepatology and GI Oncology Department, Digidune, Grenoble Alpes University Hospital, La Tronche, France., Piñero F; Hospital Universitario Austral, School of Medicine, Austral University, Buenos Aires, Argentina.; Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires, Argentina., Degroote H; Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium., Notarpaolo A; Arcispedale Santa Maria Nuova, Reggio Emilia, Italy., Boin IF; Hospital das Clinicas UNICAMP, Campiñas, Brazil., Boudjema K; Department of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital Rennes 1 University, Rennes, France., Baccaro C; Lanciano's Hospital, Chieti, Rome, Italy., Podestá LG; Hospital Universitario Austral, School of Medicine, Austral University, Buenos Aires, Argentina.; Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires, Argentina., Bachellier P; Digestive Surgery Unit, CHU de Strasbourg, Strasbourg, France., Ettorre GM; Ospedale San Camillo di Roma, Rome, Italy., Poniachik J; Hospital Clínico de la Universidad de Chile, Santiago, Chile., Muscari F; Digestive Surgery and Transplant Unit, Hôpital Rangueil, Toulouse, France., Dibenedetto F; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of General Surgery, University of Modena and Reggio Emilia, Modena, Italy., Duque SH; Hospital Pablo Tobón Uribe y Grupo de Gastrohepatología de la Universidad de Antioquía, Medellín, Colombia., Salame E; Digestive Surgery Unit, CHU de Tours, Tours, France., Cillo U; Hepatobiliary Surgery and Liver Transplant Unit, Padova University Hospital, Padua, Italy., Marciano S; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Vanlemmens C; Hepatology Unit, Hôpital Jean Minjoz, Besançon, France., Fagiuoli S; Gastroenterology, Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy., Burra P; Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padua, Italy., Van Vlierberghe H; Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium., Cherqui D; Hospital Paul Brousse, University of Paris, Paris, France., Lai Q; General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Rome, Italy., Silva M; Hospital Universitario Austral, School of Medicine, Austral University, Buenos Aires, Argentina.; Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires, Argentina., Rubinstein F; Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina., Duvoux C; Hospital Henri Mondor, University of Paris-Est, Creteil, France.
Jazyk:	angličtina
Zdroj:	JHEP reports : innovation in hepatology [JHEP Rep] 2022 Feb 02; Vol. 4 (5), pp. 100445. Date of Electronic Publication: 2022 Feb 02 (Print Publication: 2022).
DOI:	10.1016/j.jhepr.2022.100445
Abstrakt:	Background & Aims: Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods: Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results: In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3-6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101-1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber's c-index was 0.76 (95% CI 0.72-0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72-0.79; p  = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1-2 points; 15.1%), high (3-6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber's c-index of 0.78; 95% CI 0.73-0.83). Conclusions: The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration: NCT03775863. Lay Summary: Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT. Competing Interests: The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details. (© 2022 The Author(s).)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu