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AFP score and metroticket 2.0 perform similarly and could be used in a “within-ALL” clinical decision tool

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dc.contributor.authorPiñero, Federico
dc.contributor.authorCostentin, Charlotte
dc.contributor.authorDegroote, Helena
dc.contributor.authorFSF., Andrea
dc.contributor.authorBoudjema, Karim
dc.contributor.authorBaccaro, Cinzia
dc.contributor.authorChagas, Aline
dc.contributor.authorBachellier, Philippe
dc.contributor.authorEttorre, Giuseppe
dc.contributor.authorPoniachik, Jaime
dc.contributor.authorMuscari, Fabrice
dc.contributor.authorDibenedetto, Fabrizio
dc.contributor.authorHoyos, Sergio
dc.contributor.authorSalame, Ephrem
dc.contributor.authorCillo, Umberto
dc.contributor.authorMarciano, Sebastián
dc.contributor.authorVanlemmens, Claire
dc.contributor.authorFagiuoli, Stefano
dc.contributor.authorCarrilho, Flair
dc.contributor.authorCherqui, Daniel
dc.contributor.authorBurra, Patrizia
dc.contributor.authorVan Vlierberghe, Hans
dc.contributor.authorLai, Quirino
dc.contributor.authorSilva, Marcelo
dc.contributor.authorRubinstein, Fernando
dc.contributor.authorDuvoux, Christophe
dc.date.accessioned2023-04-27T13:36:09Z
dc.date.available2023-04-27T13:36:09Z
dc.date.issued2022
dc.description.abstractBackground & 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.
dc.description.versionVersión Publicada
dc.identifier.citationPiñero F, Costentin C, Degroote H, Notarpaolo A, Boin IF, Boudjema K, Baccaro C, Chagas A, Bachellier P, Ettorre GM, Poniachik J, Muscari F, Dibenedetto F, Duque SH, Salame E, Cillo U, Marciano S, Vanlemmens C, Fagiuoli S, Carrilho F, Cherqui D, Burra P, Van Vlierberghe H, Lai Q, Silva M, Rubinstein F, Duvoux C; collaborative group for HCC and liver transplantation; France; Latin America; Italy; Belgium. AFP score and metroticket 2.0 perform similarly and could be used in a "within-ALL" clinical decision tool. JHEP Rep. 2022 Dec 5;5(2):100644. doi: 10.1016/j.jhepr.2022.100644
dc.identifier.doihttps://doi.org/10.1016/j.jhepr.2022.100644
dc.identifier.urihttps://repositorio.udd.cl/handle/11447/7411
dc.language.isoen
dc.subjectAFP
dc.subjectAlpha-fetoprotein
dc.subjectHCC
dc.subjectHepatocellular carcinoma
dc.subjectHR
dc.subjectHazard ratio
dc.subjectLT
dc.subjectLiver transplantation
dc.subjectNRI
dc.subjectNet reclassification index
dc.subjectPrediction
dc.subjectSHR
dc.subjectSub-hazard ratio
dc.subjectReclassification
dc.subjectRecurrence
dc.subjectTransplantation
dc.titleAFP score and metroticket 2.0 perform similarly and could be used in a “within-ALL” clinical decision tool
dc.typeArticle
dcterms.accessRightsAcceso abierto
dcterms.sourceJHEP reports : innovation in hepatology
dspace.entity.typePublication

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