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

Autor: Christophe, Duvoux, Françoise, Roudot-Thoraval, Thomas, Decaens, Fabienne, Pessione, Hanaa, Badran, Tullio, Piardi, Claire, Francoz, Philippe, Compagnon, Claire, Vanlemmens, Jérome, Dumortier, Sébastien, Dharancy, Jean, Gugenheim, Pierre-Henri, Bernard, René, Adam, Sylvie, Radenne, Fabrice, Muscari, Filomena, Conti, Jean, Hardwigsen, Georges-Philippe, Pageaux, Olivier, Chazouillères, Ephrem, Salame, Marie-Noelle, Hilleret, Pascal, Lebray, Armand, Abergel, Marilyne, Debette-Gratien, Michael D, Kluger, Ariane, Mallat, Daniel, Azoulay, Daniel, Cherqui, Stephane, Bouvier
Přispěvatelé: Le Corre, Morgane, 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], 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, 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), 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), Service d'hépatologie [CHU Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Chirurgie, Assistance Publique - Hôpitaux de Marseille (APHM)-Hospices Civiles de Marseille-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), 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), CHU Etaing, Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges], CHU Limoges, CHU Saint-Antoine [AP-HP], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Service d'hépatologie [Saint-Antoine], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Male
medicine.medical_treatment
030230 surgery
Liver transplantation
Gastroenterology
MESH: Proportional Hazards Models
0302 clinical medicine
MESH: Practice Guidelines as Topic
MESH: Liver Neoplasms
Medicine
MESH: Carcinoma
Hepatocellular
MESH: Middle Aged
Liver Neoplasms
Middle Aged
MESH: Predictive Value of Tests
Hepatocellular carcinoma
Predictive value of tests
Area Under Curve
Practice Guidelines as Topic
030211 gastroenterology & hepatology
Female
alpha-Fetoproteins
MESH: Neoplasm Recurrence
Local
Adult
medicine.medical_specialty
MESH: Liver Transplantation
Carcinoma
Hepatocellular
AFP
Milan criteria
MESH: Multivariate Analysis
Decision Support Techniques
03 medical and health sciences
Predictive Value of Tests
Internal medicine
Carcinoma
Humans
Neoplasm Invasiveness
MESH: Patient Selection
Proportional Hazards Models
MESH: Humans
Hepatology
Receiver operating characteristic
business.industry
Proportional hazards model
Patient Selection
MESH: Decision Support Techniques
MESH: Adult
[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
Hepatocellular Carcinoma
MESH: Neoplasm Invasiveness
medicine.disease
Confidence interval
[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
MESH: Male
Surgery
Liver Transplantation
Multivariate Analysis
MESH: Area Under Curve
MESH: alpha-Fetoproteins
Neoplasm Recurrence
Local
business
MESH: Female
Zdroj: Gastroenterology
Gastroenterology, 2012, 143 (4), pp.986-94.e3; quiz e14-5. ⟨10.1053/j.gastro.2012.05.052⟩
Gastroenterology, WB Saunders, 2012, 143 (4), pp.986-94.e3; quiz e14-5. ⟨10.1053/j.gastro.2012.05.052⟩
Gastroenterology, Elsevier, 2012, 143 (4), pp.986-94.e3; quiz e14-5. ⟨10.1053/j.gastro.2012.05.052⟩
ISSN: 0016-5085
1528-0012
Popis: International audience; 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.
Databáze: OpenAIRE
Externí odkaz: