Costentin Charlotte E, Amaddeo Giuliana, Decaens Thomas, Boudjema Karim, Bachellier Philippe, Muscari Fabrice, Salamé Ephrem, Bernard Pierre-Henri, Francoz Claire, Dharancy Sébastien, Vanlemmens Claire, Radenne Sylvie, Dumortier Jérôme, Hilleret Marie-Noelle, Chazouillères Olivier, Pageaux Georges P, Calderaro Julien, Laurent Alexis, Roudot-Thoraval Françoise, Duvoux Christophe
Service d'hépatologie, Hôpital Henri Mondor, Créteil, France.
Service d'hépatologie, CHU Grenoble Alpes, Grenoble, France.
Liver Int. 2017 May;37(5):717-726. doi: 10.1111/liv.13388. Epub 2017 Mar 24.
Discordance between pre-LT imaging and explanted liver findings have been reported after liver transplantation (LT) for hepatocellular carcinoma (HCC), suggesting the need of reassessing the risk of HCC recurrence post-LT. Our aims were to compare pre-LT imaging and explants features and to test the performances of four explant-based predictive models of recurrence in an external cohort.
Staging according to pre-LT imaging and explant features were compared. Four explants-based models were retrospectively tested in a cohort of 372 patients transplanted for HCC in 19 French centres between 2003 and 2005. Accuracies of the scores were compared.
Pre-LT imaging underestimated tumour burden in 83 (22.7%) patients according to Milan criteria. The highest AUCs for prediction of 5-years recurrence were observed in the "Up to seven" (0.7915 [95% CI: 0.7339-0.849]) and Decaens models (0.747 [95% CI: 0.6877-0.806]), with two levels of risk: low (10%) and high (>50%). Chan and Iwatsuki models identified 3 and 4 levels of risk, but had lower AUCs (0.68 and 0.70) respectively. Accuracy of the "Up to seven" model was superior to the Decaens model (P=.034), which was superior to the Chan model (P=.0041) but not to the Iwatsuki model (P=.17).
Pre-LT imaging underestimates tumour burden, and prediction of recurrence should be reassessed after LT. The explant-based "Up to seven" and Decaens models provided the best accuracy for prediction of 5-year recurrence, identifying only two levels of risk. New models are needed to further refine the prediction of recurrence after LT.
肝细胞癌（HCC）肝移植（LT）后，有报道称LT前影像学检查结果与移植肝发现不一致，这表明需要重新评估LT后HCC复发风险。我们的目的是比较LT前影像学检查和移植肝特征，并在外部队列中测试四种基于移植肝的复发预测模型的性能。
比较根据LT前影像学检查和移植肝特征进行的分期。在2003年至2005年间，对法国19个中心的372例因HCC接受移植的患者队列进行回顾性测试，采用四种基于移植肝的模型。比较各评分的准确性。
根据米兰标准，LT前影像学检查低估了83例（22.7%）患者的肿瘤负荷。在“最多七个”模型（0.7915 [95% CI：0.7339 - 0.849]）和德凯恩模型（0.747 [95% CI：0.6877 - 0.806]）中观察到预测5年复发的最高曲线下面积（AUC），有低（10%）和高（>50%）两个风险水平。陈和岩月模型确定了3个和4个风险水平，但AUC较低，分别为0.68和0.70。“最多七个”模型的准确性优于德凯恩模型（P = 0.034），德凯恩模型优于陈模型（P = 0.0041），但不优于岩月模型（P = 0.17）。
LT前影像学检查低估了肿瘤负荷，LT后复发预测应重新评估。基于移植肝的“最多七个”和德凯恩模型在预测5年复发方面准确性最佳，仅识别出两个风险水平。需要新的模型来进一步优化LT后复发的预测。
