R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation

ABSTRACT: Background & aims: Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods: Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results: In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3-6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101-1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber's c-index was 0.76 (95% CI 0.72-0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72-0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1-2 points; 15.1%), high (3-6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber's c-index of 0.78; 95% CI 0.73-0.83). Conclusions: The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria.

• Autores: Hoyos Duque, Sergio Iván; Costentin, Charlotte; Degroote, Helena; Notarpaolo, Andrea; Boin, Ilka F.; Boudjema, Karim; Baccaro, Cinzia; Podestá, Luis G.; Bachellier, Philippe; Ettorre, Giuseppe Maria; Poniachik, Jaime; Muscari, Fabrice; Dibenedetto, Fabrizio; Piñero, Federico; Salame, Ephrem; Cillo, Umberto; Marciano, Sebastián; Vanlemmens, Claire; Fagiuoli, Stefano; Burra, Patrizia; Van Vlierberghe, Hans; Cherqui, Daniel; Lai, Quirino; Silva, Marcelo; Rubinstein, Fernando; Duvoux, Christophe
• Tipo de recurso: Article of investigation
• Fecha de publicación: 2022
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/39795
• Acceso en línea: https://hdl.handle.net/10495/39795
• Palabra clave: Trasplante de Hígado; Liver Transplantation; Neoplasias Hepáticas; Liver Neoplasms; Recurrencia; Recurrence; Recurrencia; Virus de la Hepatitis B; Hepatitis B virus; alfa-Fetoproteínas; alpha-Fetoproteins; Carcinoma Hepatocelular; Carcinoma, Hepatocellular; Hepacivirus; https://id.nlm.nih.gov/mesh/D016031; https://id.nlm.nih.gov/mesh/D008113; https://id.nlm.nih.gov/mesh/D012008; https://id.nlm.nih.gov/mesh/D006515; https://id.nlm.nih.gov/mesh/D000509; https://id.nlm.nih.gov/mesh/D006528; https://id.nlm.nih.gov/mesh/D016174
• Rights: openAccess
• License: https://creativecommons.org/licenses/by-nc-nd/4.0/