Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Duvoux, C., Roudot-Thoraval, F., Decaens, T., Pessione, F., Badran, H., Piardi, T., Francoz, C., Compagnon, P., Vanlemmens, C., Dumortier, J., Dharancy, S., Gugenheim, J., Bernard, P. H., Adam, R., Radenne, S., Muscari, F., Conti, F., Hardwigsen, J., Pageaux, G. P., Chazouilleres, O., Salame, E., Hilleret, M. N., Lebray, P., Abergel, A., Debette-Gratien, M., Kluger, M. D., Mallat, A., Azoulay, D., & Cherqui, D. Gastroenterology, 143(4):986–94 e3; quiz e14–5, October, 2012.
Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria [link]Paper  abstract   bibtex   
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: alpha-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 \textless .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 \textless .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.
@article{duvoux_liver_2012-1,
	title = {Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of {Milan} criteria},
	volume = {143},
	issn = {1528-0012 (ELECTRONIC); 0016-5085 (LINKING)},
	shorttitle = {Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of {Milan} criteria},
	url = {http://www.ncbi.nlm.nih.gov/pubmed/22750200},
	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: alpha-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 {\textless} .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 {\textless} .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.},
	number = {4},
	journal = {Gastroenterology},
	author = {Duvoux, C. and Roudot-Thoraval, F. and Decaens, T. and Pessione, F. and Badran, H. and Piardi, T. and Francoz, C. and Compagnon, P. and Vanlemmens, C. and Dumortier, J. and Dharancy, S. and Gugenheim, J. and Bernard, P. H. and Adam, R. and Radenne, S. and Muscari, F. and Conti, F. and Hardwigsen, J. and Pageaux, G. P. and Chazouilleres, O. and Salame, E. and Hilleret, M. N. and Lebray, P. and Abergel, A. and Debette-Gratien, M. and Kluger, M. D. and Mallat, A. and Azoulay, D. and Cherqui, D.},
	month = oct,
	year = {2012},
	pages = {986--94 e3; quiz e14--5}
}

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