Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria
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 transplante...
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| Veröffentlicht in: | Gastroenterology (New York, N.Y. 1943) N.Y. 1943), 2012-10, Vol.143 (4), p.986-994.e3 |
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| container_title | Gastroenterology (New York, N.Y. 1943) |
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| creator | 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 D Mallat, Ariane Azoulay, Daniel Cherqui, Daniel |
| 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 log10 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. |
| doi_str_mv | 10.1053/j.gastro.2012.05.052 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_inserm_00865368v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0016508512009419</els_id><sourcerecordid>1080624069</sourcerecordid><originalsourceid>FETCH-LOGICAL-c500t-be218defa3fab38e59fa14292ff9672a805dc18d9c3b7425eff3c7ad851c35063</originalsourceid><addsrcrecordid>eNqFUsFuEzEQXSEQDYU_QMhHDt0w9sabXQ5IUURJpFQgUc7WxDtuHXbtYHsj9cQ38SP9pjpK6YEL0khjWW_e07w3RfGWw5SDrD7spjcYU_BTAVxMQeYSz4oJl6IpIX89Lya51aWERp4Vr2LcAUBbNfxlcSbEXIIAmBS_N_ZAgV0HdHHfo0uYrHfM-MBWtMfkNfX92GNgSwzaOj_gR7ZgV76jnq2d7sfOuht2_6e8pOT3wSeyjq2H_DpQZOmW2DcKmW5Ap4l5w65slmHLYBMFi6-LFwb7SG8e-3nx4_Lz9XJVbr5-WS8Xm1JLgFRuSfCmI4OVwW3VkGwN8plohTFtPRfYgOx0RrS62s5nQpIxlZ5j10iuKwl1dV5cnHhvsVf7YAcMd8qjVavFRlkXKQwKoKllVTcHnuHvT_C8x6-RYlKDjUcr0JEfo-LQQC1mULcZOjtBdfAxBjJP9BzUMSm1U6ek1DEpBTKXyGPvHhXG7UDd09DfaDLg0wlA2ZaDpaCitpRN7GwgnVTn7f8U_iXQvXVWY_-T7iju_BhctlxxFfOM-n68luOx8KzeznhbPQB0a71o</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1080624069</pqid></control><display><type>article</type><title>Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Alma/SFX Local Collection</source><creator>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 D ; Mallat, Ariane ; Azoulay, Daniel ; Cherqui, Daniel</creator><creatorcontrib>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 D ; Mallat, Ariane ; Azoulay, Daniel ; Cherqui, Daniel ; Liver Transplantation French Study Group</creatorcontrib><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 log10 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.</description><identifier>ISSN: 0016-5085</identifier><identifier>EISSN: 1528-0012</identifier><identifier>DOI: 10.1053/j.gastro.2012.05.052</identifier><identifier>PMID: 22750200</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; AFP ; alpha-Fetoproteins ; alpha-Fetoproteins - metabolism ; Area Under Curve ; Carcinoma, Hepatocellular ; Carcinoma, Hepatocellular - blood ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - surgery ; Decision Support Techniques ; Female ; Gastroenterology and Hepatology ; Hepatocellular Carcinoma ; Human health and pathology ; Humans ; Hépatology and Gastroenterology ; Life Sciences ; Liver Neoplasms ; Liver Neoplasms - blood ; Liver Neoplasms - pathology ; Liver Neoplasms - surgery ; Liver Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Neoplasm Recurrence, Local - blood ; Patient Selection ; Practice Guidelines as Topic ; Predictive Value of Tests ; Proportional Hazards Models</subject><ispartof>Gastroenterology (New York, N.Y. 1943), 2012-10, Vol.143 (4), p.986-994.e3</ispartof><rights>AGA Institute</rights><rights>2012 AGA Institute</rights><rights>Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c500t-be218defa3fab38e59fa14292ff9672a805dc18d9c3b7425eff3c7ad851c35063</citedby><cites>FETCH-LOGICAL-c500t-be218defa3fab38e59fa14292ff9672a805dc18d9c3b7425eff3c7ad851c35063</cites><orcidid>0000-0002-7824-5396 ; 0000-0001-5269-8373 ; 0000-0003-0928-0048 ; 0000-0001-7480-1052 ; 0000-0001-7789-7264 ; 0000-0001-6754-1686</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0016508512009419$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22750200$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://inserm.hal.science/inserm-00865368$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Duvoux, Christophe</creatorcontrib><creatorcontrib>Roudot–Thoraval, Françoise</creatorcontrib><creatorcontrib>Decaens, Thomas</creatorcontrib><creatorcontrib>Pessione, Fabienne</creatorcontrib><creatorcontrib>Badran, Hanaa</creatorcontrib><creatorcontrib>Piardi, Tullio</creatorcontrib><creatorcontrib>Francoz, Claire</creatorcontrib><creatorcontrib>Compagnon, Philippe</creatorcontrib><creatorcontrib>Vanlemmens, Claire</creatorcontrib><creatorcontrib>Dumortier, Jérome</creatorcontrib><creatorcontrib>Dharancy, Sébastien</creatorcontrib><creatorcontrib>Gugenheim, Jean</creatorcontrib><creatorcontrib>Bernard, Pierre–Henri</creatorcontrib><creatorcontrib>Adam, René</creatorcontrib><creatorcontrib>Radenne, Sylvie</creatorcontrib><creatorcontrib>Muscari, Fabrice</creatorcontrib><creatorcontrib>Conti, Filomena</creatorcontrib><creatorcontrib>Hardwigsen, Jean</creatorcontrib><creatorcontrib>Pageaux, Georges–Philippe</creatorcontrib><creatorcontrib>Chazouillères, Olivier</creatorcontrib><creatorcontrib>Salame, Ephrem</creatorcontrib><creatorcontrib>Hilleret, Marie–Noelle</creatorcontrib><creatorcontrib>Lebray, Pascal</creatorcontrib><creatorcontrib>Abergel, Armand</creatorcontrib><creatorcontrib>Debette–Gratien, Marilyne</creatorcontrib><creatorcontrib>Kluger, Michael D</creatorcontrib><creatorcontrib>Mallat, Ariane</creatorcontrib><creatorcontrib>Azoulay, Daniel</creatorcontrib><creatorcontrib>Cherqui, Daniel</creatorcontrib><creatorcontrib>Liver Transplantation French Study Group</creatorcontrib><title>Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria</title><title>Gastroenterology (New York, N.Y. 1943)</title><addtitle>Gastroenterology</addtitle><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 log10 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.</description><subject>Adult</subject><subject>AFP</subject><subject>alpha-Fetoproteins</subject><subject>alpha-Fetoproteins - metabolism</subject><subject>Area Under Curve</subject><subject>Carcinoma, Hepatocellular</subject><subject>Carcinoma, Hepatocellular - blood</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>Decision Support Techniques</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Hepatocellular Carcinoma</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hépatology and Gastroenterology</subject><subject>Life Sciences</subject><subject>Liver Neoplasms</subject><subject>Liver Neoplasms - blood</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver Transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Recurrence, Local</subject><subject>Neoplasm Recurrence, Local - blood</subject><subject>Patient Selection</subject><subject>Practice Guidelines as Topic</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><issn>0016-5085</issn><issn>1528-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsFuEzEQXSEQDYU_QMhHDt0w9sabXQ5IUURJpFQgUc7WxDtuHXbtYHsj9cQ38SP9pjpK6YEL0khjWW_e07w3RfGWw5SDrD7spjcYU_BTAVxMQeYSz4oJl6IpIX89Lya51aWERp4Vr2LcAUBbNfxlcSbEXIIAmBS_N_ZAgV0HdHHfo0uYrHfM-MBWtMfkNfX92GNgSwzaOj_gR7ZgV76jnq2d7sfOuht2_6e8pOT3wSeyjq2H_DpQZOmW2DcKmW5Ap4l5w65slmHLYBMFi6-LFwb7SG8e-3nx4_Lz9XJVbr5-WS8Xm1JLgFRuSfCmI4OVwW3VkGwN8plohTFtPRfYgOx0RrS62s5nQpIxlZ5j10iuKwl1dV5cnHhvsVf7YAcMd8qjVavFRlkXKQwKoKllVTcHnuHvT_C8x6-RYlKDjUcr0JEfo-LQQC1mULcZOjtBdfAxBjJP9BzUMSm1U6ek1DEpBTKXyGPvHhXG7UDd09DfaDLg0wlA2ZaDpaCitpRN7GwgnVTn7f8U_iXQvXVWY_-T7iju_BhctlxxFfOM-n68luOx8KzeznhbPQB0a71o</recordid><startdate>20121001</startdate><enddate>20121001</enddate><creator>Duvoux, Christophe</creator><creator>Roudot–Thoraval, Françoise</creator><creator>Decaens, Thomas</creator><creator>Pessione, Fabienne</creator><creator>Badran, Hanaa</creator><creator>Piardi, Tullio</creator><creator>Francoz, Claire</creator><creator>Compagnon, Philippe</creator><creator>Vanlemmens, Claire</creator><creator>Dumortier, Jérome</creator><creator>Dharancy, Sébastien</creator><creator>Gugenheim, Jean</creator><creator>Bernard, Pierre–Henri</creator><creator>Adam, René</creator><creator>Radenne, Sylvie</creator><creator>Muscari, Fabrice</creator><creator>Conti, Filomena</creator><creator>Hardwigsen, Jean</creator><creator>Pageaux, Georges–Philippe</creator><creator>Chazouillères, Olivier</creator><creator>Salame, Ephrem</creator><creator>Hilleret, Marie–Noelle</creator><creator>Lebray, Pascal</creator><creator>Abergel, Armand</creator><creator>Debette–Gratien, Marilyne</creator><creator>Kluger, Michael D</creator><creator>Mallat, Ariane</creator><creator>Azoulay, Daniel</creator><creator>Cherqui, Daniel</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-7824-5396</orcidid><orcidid>https://orcid.org/0000-0001-5269-8373</orcidid><orcidid>https://orcid.org/0000-0003-0928-0048</orcidid><orcidid>https://orcid.org/0000-0001-7480-1052</orcidid><orcidid>https://orcid.org/0000-0001-7789-7264</orcidid><orcidid>https://orcid.org/0000-0001-6754-1686</orcidid></search><sort><creationdate>20121001</creationdate><title>Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria</title><author>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 D ; Mallat, Ariane ; Azoulay, Daniel ; Cherqui, Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c500t-be218defa3fab38e59fa14292ff9672a805dc18d9c3b7425eff3c7ad851c35063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>AFP</topic><topic>alpha-Fetoproteins</topic><topic>alpha-Fetoproteins - metabolism</topic><topic>Area Under Curve</topic><topic>Carcinoma, Hepatocellular</topic><topic>Carcinoma, Hepatocellular - blood</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>Decision Support Techniques</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Hepatocellular Carcinoma</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hépatology and Gastroenterology</topic><topic>Life Sciences</topic><topic>Liver Neoplasms</topic><topic>Liver Neoplasms - blood</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver Transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Recurrence, Local</topic><topic>Neoplasm Recurrence, Local - blood</topic><topic>Patient Selection</topic><topic>Practice Guidelines as Topic</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Duvoux, Christophe</creatorcontrib><creatorcontrib>Roudot–Thoraval, Françoise</creatorcontrib><creatorcontrib>Decaens, Thomas</creatorcontrib><creatorcontrib>Pessione, Fabienne</creatorcontrib><creatorcontrib>Badran, Hanaa</creatorcontrib><creatorcontrib>Piardi, Tullio</creatorcontrib><creatorcontrib>Francoz, Claire</creatorcontrib><creatorcontrib>Compagnon, Philippe</creatorcontrib><creatorcontrib>Vanlemmens, Claire</creatorcontrib><creatorcontrib>Dumortier, Jérome</creatorcontrib><creatorcontrib>Dharancy, Sébastien</creatorcontrib><creatorcontrib>Gugenheim, Jean</creatorcontrib><creatorcontrib>Bernard, Pierre–Henri</creatorcontrib><creatorcontrib>Adam, René</creatorcontrib><creatorcontrib>Radenne, Sylvie</creatorcontrib><creatorcontrib>Muscari, Fabrice</creatorcontrib><creatorcontrib>Conti, Filomena</creatorcontrib><creatorcontrib>Hardwigsen, Jean</creatorcontrib><creatorcontrib>Pageaux, Georges–Philippe</creatorcontrib><creatorcontrib>Chazouillères, Olivier</creatorcontrib><creatorcontrib>Salame, Ephrem</creatorcontrib><creatorcontrib>Hilleret, Marie–Noelle</creatorcontrib><creatorcontrib>Lebray, Pascal</creatorcontrib><creatorcontrib>Abergel, Armand</creatorcontrib><creatorcontrib>Debette–Gratien, Marilyne</creatorcontrib><creatorcontrib>Kluger, Michael D</creatorcontrib><creatorcontrib>Mallat, Ariane</creatorcontrib><creatorcontrib>Azoulay, Daniel</creatorcontrib><creatorcontrib>Cherqui, Daniel</creatorcontrib><creatorcontrib>Liver Transplantation French Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duvoux, Christophe</au><au>Roudot–Thoraval, Françoise</au><au>Decaens, Thomas</au><au>Pessione, Fabienne</au><au>Badran, Hanaa</au><au>Piardi, Tullio</au><au>Francoz, Claire</au><au>Compagnon, Philippe</au><au>Vanlemmens, Claire</au><au>Dumortier, Jérome</au><au>Dharancy, Sébastien</au><au>Gugenheim, Jean</au><au>Bernard, Pierre–Henri</au><au>Adam, René</au><au>Radenne, Sylvie</au><au>Muscari, Fabrice</au><au>Conti, Filomena</au><au>Hardwigsen, Jean</au><au>Pageaux, Georges–Philippe</au><au>Chazouillères, Olivier</au><au>Salame, Ephrem</au><au>Hilleret, Marie–Noelle</au><au>Lebray, Pascal</au><au>Abergel, Armand</au><au>Debette–Gratien, Marilyne</au><au>Kluger, Michael D</au><au>Mallat, Ariane</au><au>Azoulay, Daniel</au><au>Cherqui, Daniel</au><aucorp>Liver Transplantation French Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria</atitle><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle><addtitle>Gastroenterology</addtitle><date>2012-10-01</date><risdate>2012</risdate><volume>143</volume><issue>4</issue><spage>986</spage><epage>994.e3</epage><pages>986-994.e3</pages><issn>0016-5085</issn><eissn>1528-0012</eissn><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 log10 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><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22750200</pmid><doi>10.1053/j.gastro.2012.05.052</doi><orcidid>https://orcid.org/0000-0002-7824-5396</orcidid><orcidid>https://orcid.org/0000-0001-5269-8373</orcidid><orcidid>https://orcid.org/0000-0003-0928-0048</orcidid><orcidid>https://orcid.org/0000-0001-7480-1052</orcidid><orcidid>https://orcid.org/0000-0001-7789-7264</orcidid><orcidid>https://orcid.org/0000-0001-6754-1686</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0016-5085 |
| ispartof | Gastroenterology (New York, N.Y. 1943), 2012-10, Vol.143 (4), p.986-994.e3 |
| issn | 0016-5085 1528-0012 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_inserm_00865368v1 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Alma/SFX Local Collection |
| subjects | Adult AFP alpha-Fetoproteins alpha-Fetoproteins - metabolism Area Under Curve Carcinoma, Hepatocellular Carcinoma, Hepatocellular - blood Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - surgery Decision Support Techniques Female Gastroenterology and Hepatology Hepatocellular Carcinoma Human health and pathology Humans Hépatology and Gastroenterology Life Sciences Liver Neoplasms Liver Neoplasms - blood Liver Neoplasms - pathology Liver Neoplasms - surgery Liver Transplantation Male Middle Aged Multivariate Analysis Neoplasm Invasiveness Neoplasm Recurrence, Local Neoplasm Recurrence, Local - blood Patient Selection Practice Guidelines as Topic Predictive Value of Tests Proportional Hazards Models |
| title | Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T23%3A09%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_hal_p&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Liver%20Transplantation%20for%20Hepatocellular%20Carcinoma:%20A%20Model%20Including%20%CE%B1-Fetoprotein%20Improves%20the%20Performance%20of%20Milan%20Criteria&rft.jtitle=Gastroenterology%20(New%20York,%20N.Y.%201943)&rft.au=Duvoux,%20Christophe&rft.aucorp=Liver%20Transplantation%20French%20Study%20Group&rft.date=2012-10-01&rft.volume=143&rft.issue=4&rft.spage=986&rft.epage=994.e3&rft.pages=986-994.e3&rft.issn=0016-5085&rft.eissn=1528-0012&rft_id=info:doi/10.1053/j.gastro.2012.05.052&rft_dat=%3Cproquest_hal_p%3E1080624069%3C/proquest_hal_p%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1080624069&rft_id=info:pmid/22750200&rft_els_id=1_s2_0_S0016508512009419&rfr_iscdi=true |