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 de Fátima Santana Ferreira Boin, Karim Boudjéma, Cinzia Baccaro, Aline Lopes Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poníachik, Fabrice Muscari, Fabrizio Di Benedetto, Sergio Hoyos Duque, Ephrem Salamé, Umberto Cillo, Sebastián Marciano, Claire Vanlemmens, S. Fagiuoli, Flair José Carrilho, Daniel Cherqui, Patrizia Burra, Hans Van Vlierberghe, Quirino Lai, Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Filoména Conti, Olivier Scatton, Pierre Bernard, Claire Francoz, François Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel‐Debry, Georges‐Philippe Pageaux, L. Chiche, V DELEDINGHEN, Jean Hardwigsen, Jean Gugenheim, Mario Altieri, Marie Noelle Hilleret, Thomas Decaens, Paulo Everton Garcia Costa, Elaine Cristina de Ataíde, Emilio Quiñones, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatobá, Linda E. Muñoz‐Espinosa, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, Lucas McCormack, Juan Mattera, Adrián Gadano, Jose Huygens Parente García, Giulia Magini, L. Miglioresi, Martina Gambato, C. D’Ambrosio, Alessandro Vitale, M. Colledan, D. Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, V. Giannelli, Adriano Pellicelli, Eduard Callebout, Samuele Iesari, Jeroen Dekervel, Jonas Schreiber, Pirenne Jacques, Chris Verslype, Dirk Ysebaert, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Jean Delwaide, Troisi Roberto, Lerut Jan Paul
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: 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.