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Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria
- Source :
- 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⟩
- Publication Year :
- 2012
- Publisher :
- HAL CCSD, 2012.
-
Abstract
- 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.
- Subjects :
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 00165085 and 15280012
- Database :
- OpenAIRE
- Journal :
- 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⟩
- Accession number :
- edsair.doi.dedup.....cd1cf26a03348c35cdbb2740aeaa27b7