JHEP Reports (Feb 2023)
AFP score and metroticket 2.0 perform similarly and could be used in a “within-ALL” clinical decision tool
- Federico Piñero,
- Charlotte Costentin,
- Helena Degroote,
- Andrea Notarpaolo,
- Ilka FSF. Boin,
- Karim Boudjema,
- Cinzia Baccaro,
- Aline Chagas,
- Philippe Bachellier,
- Giuseppe Maria Ettorre,
- Jaime Poniachik,
- Fabrice Muscari,
- Fabrizio Dibenedetto,
- Sergio Hoyos Duque,
- Ephrem Salame,
- Umberto Cillo,
- Sebastián Marciano,
- Claire Vanlemmens,
- Stefano Fagiuoli,
- Flair Carrilho,
- Daniel Cherqui,
- Patrizia Burra,
- Hans Van Vlierberghe,
- Quirino Lai,
- Marcelo Silva,
- Fernando Rubinstein,
- Christophe Duvoux,
- Filomena Conti,
- Olivier Scatton,
- Pierre Henri Bernard,
- Claire Francoz,
- Francois Durand,
- Sébastien Dharancy,
- Marie-lorraine Woehl,
- Alexis Laurent,
- Sylvie Radenne,
- Jérôme Dumortier,
- Armand Abergel,
- Louise Barbier,
- Pauline Houssel-Debry,
- Georges Philippe Pageaux,
- Laurence Chiche,
- Victor Deledinghen,
- Jean Hardwigsen,
- J. Gugenheim,
- M. altieri,
- Marie Noelle Hilleret,
- Thomas Decaens,
- Paulo Costa,
- Elaine Cristina de Ataide,
- Emilio Quiñones,
- Margarita Anders,
- Adriana Varón,
- Alina Zerega,
- Alejandro Soza,
- Martín Padilla Machaca,
- Diego Arufe,
- Josemaría Menéndez,
- Rodrigo Zapata,
- Mario Vilatoba,
- Linda Muñoz,
- Ricardo Chong Menéndez,
- Martín Maraschio,
- Luis G. Podestá,
- Lucas McCormack,
- Juan Mattera,
- Adrian Gadano,
- Jose Huygens Parente García,
- Giulia Magini,
- Lucia Miglioresi,
- Martina Gambato,
- Cecilia D’Ambrosio,
- Alessandro Vitale,
- Michele Colledan,
- Domenico Pinelli,
- Paolo Magistri,
- Giovanni Vennarecci,
- Marco Colasanti,
- Valerio Giannelli,
- Adriano Pellicelli,
- Callebout Eduard,
- Iesari Samuele,
- Dekervel Jeroen,
- Schreiber Jonas,
- Pirenne Jacques,
- Verslype Chris,
- Ysebaert Dirk,
- Michielsen Peter,
- Lucidi Valerio,
- Moreno Christophe,
- Detry Olivier,
- Delwaide Jean,
- Troisi Roberto,
- Lerut Jan Paul
Affiliations
- Federico Piñero
- Hospital Universitario Austral, School of Medicine, Austral University, Argentina and Latin American Liver Research Educational and Awareness Network (LALREAN), Argentina; Corresponding authors. Addresses: Hospital Universitario Austral, School of Medicine, Austral University, Av Presidente Perón 1500, 1629, Pilar, Buenos Aires, Argentina
- Charlotte Costentin
- Grenoble Alpes University, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Gastroenterology, Hepatology and GI Oncology Department, Digidune, Grenoble Alpes University Hospital, La Tronche, France
- Helena Degroote
- Department of Hepatology and Gastroenterology, Ghent University Hospital, Belgium
- Andrea Notarpaolo
- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- Ilka FSF. Boin
- Hospital das Clinicas UNICAMP Campinas, Brazil
- Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital Rennes 1 University, Rennes, France
- Cinzia Baccaro
- Lanciano’s Hospital, Chieti, Rome, Italy
- Aline Chagas
- Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas Department of Gastroenterology, School of Medicine, University of São Paulo, Brazil
- Philippe Bachellier
- Digestive Surgery Unit, CHU Strasbourg, Strasbourg, France
- Giuseppe Maria Ettorre
- Ospedale San Camillo di Roma, Rome, Italy
- Jaime Poniachik
- Hospital Clínico de la Universidad de Chile, Santiago, Chile
- Fabrice Muscari
- Digestive Surgery and Transplant Unit, Hôpital Rangueil, Toulouse, France
- Fabrizio Dibenedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of General Surgery, University of Modena and Reggio Emilia, Italy
- Sergio Hoyos Duque
- Hospital Pablo Tobón Uribe y Grupo de Gastrohepatología de la Universidad de Antioquía, Medellín, Colombia
- Ephrem Salame
- Digestive Surgery Unit, CHU de Tours, Tours, France
- Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Unit, Padova University Hospital, Padova, Italy
- Sebastián Marciano
- Hospital Italiano de Buenos Aires, Argentina
- Claire Vanlemmens
- Hepatology Unit, Hôpital Juan Minjoz, Besançon, France
- Stefano Fagiuoli
- Gastroenterology, Hepatology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Flair Carrilho
- Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas Department of Gastroenterology, School of Medicine, University of São Paulo, Brazil
- Daniel Cherqui
- Hospital Paul Brousse-APHP, Villejuif, Paris, France
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
- Hans Van Vlierberghe
- Department of Hepatology and Gastroenterology, Ghent University Hospital, Belgium
- Quirino Lai
- General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Italy
- Marcelo Silva
- Hospital Universitario Austral, School of Medicine, Austral University, Argentina and Latin American Liver Research Educational and Awareness Network (LALREAN), Argentina
- Fernando Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Christophe Duvoux
- Department of Hepatology, Medical Liver Transplant Unit, Hospital Henri Mondor AP-HP, University of Paris-Est Créteil (UPEC), France; or Department of Hepatology, Medical Liver Transplant Unit, Hospital Henri Mondor AP-HP, University of Paris-Est Créteil (UPEC), 51 Avenue Maréchal de Lattre de Tassigny, 94000 Créteil, France.
- Filomena Conti
- Olivier Scatton
- Pierre Henri Bernard
- Claire Francoz
- Francois Durand
- Sébastien Dharancy
- Marie-lorraine Woehl
- Alexis Laurent
- Sylvie Radenne
- Jérôme Dumortier
- Armand Abergel
- Louise Barbier
- Pauline Houssel-Debry
- Georges Philippe Pageaux
- Laurence Chiche
- Victor Deledinghen
- Jean Hardwigsen
- J. Gugenheim
- M. altieri
- Marie Noelle Hilleret
- Thomas Decaens
- Paulo Costa
- Elaine Cristina de Ataide
- Emilio Quiñones
- Margarita Anders
- Adriana Varón
- Alina Zerega
- Alejandro Soza
- Martín Padilla Machaca
- Diego Arufe
- Josemaría Menéndez
- Rodrigo Zapata
- Mario Vilatoba
- Linda Muñoz
- Ricardo Chong Menéndez
- Martín Maraschio
- Luis G. Podestá
- Lucas McCormack
- Juan Mattera
- Adrian Gadano
- Jose Huygens Parente García
- Giulia Magini
- Lucia Miglioresi
- Martina Gambato
- Cecilia D’Ambrosio
- Alessandro Vitale
- Michele Colledan
- Domenico Pinelli
- Paolo Magistri
- Giovanni Vennarecci
- Marco Colasanti
- Valerio Giannelli
- Adriano Pellicelli
- Callebout Eduard
- Iesari Samuele
- Dekervel Jeroen
- Schreiber Jonas
- Pirenne Jacques
- Verslype Chris
- Ysebaert Dirk
- Michielsen Peter
- Lucidi Valerio
- Moreno Christophe
- Detry Olivier
- Delwaide Jean
- Troisi Roberto
- Lerut Jan Paul
- Journal volume & issue
-
Vol. 5,
no. 2
p. 100644
Abstract
Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model’s original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell’s adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model’s original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p <0.0001). At last tumor reassessment before LT, c-statistics did not significantly differ between the two composite models, either as original or threshold versions, for recurrence (0.72 vs. 0.68; p = 0.06), HCC survival, and overall survival after LT. We observed predictive gaps and overlaps between the model’s thresholds, and no significant gain on reclassification. Patients meeting both models (“within-ALL”) at last tumor reassessment presented the lowest 5-year cumulative incidence of HCC recurrence (7.7%; 95% CI 5.1-11.5) and higher 5-year post-LT survival (70.0%; 95% CI 64.9-74.6). Conclusions: In this multicenter cohort, Metroticket 2.0 and the AFP score demonstrated a similar ability to predict HCC recurrence post-LT. The combination of these composite models might be a promising clinical approach. Impact and implications: Composite models were recently proposed for the selection of liver transplant (LT) candidates among individuals with hepatocellular carcinoma (HCC). We found that both the AFP score and Metroticket 2.0 predicted post-LT HCC recurrence and survival better than Milan criteria; the Metroticket 2.0 did not result in better reclassification for transplant selection compared to the AFP score, with predictive gaps and overlaps between the two models; patients who met low-risk thresholds for both models had the lowest 5-year recurrence rate. We propose prospectively testing the combination of both models, to further optimize the LT selection process for candidates with HCC.