Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria
Liver Transplantation for Hepatocellular Carcinoma: A Model Including α-Fetoprotein Improves the Performance of Milan Criteria
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DOI：
10.1053/j.gastro.2012.05.052
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发表时间：
2012-10-01
期刊：
影响因子：
29.4
通讯作者：
Cherqui, Daniel
中科院分区：
文献类型：
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作者：
Duvoux, Christophe;Roudot-Thoraval, Francoise;Cherqui, Daniel
背景与目的：本研究的目的是建立一个改进的预测模型，用于预测肝细胞癌（HCC）肝移植候选人的复发。方法：通过考克斯模型分析，对537例肝细胞癌移植患者的训练队列进行复发预测。在一个前瞻性随访的435例患者的国家队列中开发并验证了预后评分。结果：甲胎蛋白（AFP）独立预测肿瘤复发，并与血管浸润和分化相关。在考克斯评分阈值为0.7时（受试者工作特征曲线下面积，0.701; 95%置信区间，0.63-0.76;准确度，75.8%），结合log（10）AFP、肿瘤大小和数量的模型高度预测肿瘤复发和死亡。通过使用简化版本的模型，使用未转换的AFP值，确定临界值为2。在验证队列中，与其他队列相比，评分大于2的患者5年复发风险显著增加（50.6% +/- 10.2% vs 8.8% +/- 1.7%; P <0.001），生存率降低（47.5% +/- 8.1% vs 67.8% +/- 3.4%; P = 0.002）。在超过米兰标准的患者中，评分为2或更低的患者亚组AFP水平低于100 ng/mL，5年复发风险较低（14.4% +/- 5.3% vs 47.6% +/- 11.1%; P = 0.006）。在符合米兰标准的患者中，评分大于2的患者亚组的AFP水平大于1000 ng/mL，复发风险高（37.1% +/- 8.9% vs 13.3% +/- 2.0%; P <0.001）。净重新分类的改善表明，预测的AFP模型是优于米兰标准上级。结论：结合AFP的模型显著改善了肿瘤复发的预测。我们建议采用新的肝细胞癌移植候选人的选择标准，考虑AFP。
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 < .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.