Prognostic models of liver transplantation (LT) for hepatocellular carcinoma (HCC) mainly derive from LT cohorts with numerous hepatitis C virus (HCV) patients. The AFP model, which is currently used in France to select LT candidates, was derived from a cohort of LT performed between 1988 and 2001, including a majority of HCV-positive recipients. The emergence of new direct-acting antiviral therapies and subsequent decrease of HCV incidence may change the generalizability of such models. We performed an external validation of the AFP model in a cohort of recipients transplanted between 2005 and 2018. Although multivariable analysis identified all 3 model's factors (AFP level, largest tumor size, number of nodules) as predictors of tumor recurrence, the AFP model showed poor discrimination and calibration in the present cohort. This poor performance could be related to significant differences between the derivation and the present cohort in terms of etiology, severity of underlying liver disease, tumor burden and differentiation, and use of neoadjuvant treatments. The present findings suggest that the decline of HCV-induced HCC among LT candidates may compromise the generalizability of the AFP model in more recent LT cohorts. Further studies are required for updating or building more robust prognostic models.

中文翻译：

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在最近的单中心队列中对法国 AFP 模型进行 HCC 肝移植的外部验证

肝细胞癌 (HCC) 肝移植 (LT) 的预后模型主要来自具有众多丙型肝炎病毒 (HCV) 患者的 LT 队列。目前在法国用于选择 LT 候选者的 AFP 模型源自 1988 年至 2001 年间进行的 LT 队列，其中包括大多数 HCV 阳性受者。新的直接作用抗病毒疗法的出现以及随后 HCV 发病率的降低可能会改变此类模型的普遍性。我们在 2005 年至 2018 年间移植的一组受者中对 AFP 模型进行了外部验证。虽然多变量分析将所有 3 个模型的因素（AFP 水平、最大肿瘤大小、结节数）确定为肿瘤复发的预测因子，但 AFP 模型显示当前队列中的歧视和校准较差。这种糟糕的表现可能与推导和当前队列在病因、潜在肝病的严重程度、肿瘤负荷和分化以及新辅助治疗的使用方面存在显着差异有关。目前的研究结果表明，LT 候选者中 HCV 诱导的 HCC 的下降可能会损害 AFP 模型在最近的 LT 队列中的普遍性。需要进一步的研究来更新或建立更强大的预后模型。目前的研究结果表明，LT 候选者中 HCV 诱导的 HCC 的下降可能会损害 AFP 模型在最近的 LT 队列中的普遍性。需要进一步的研究来更新或建立更强大的预后模型。目前的研究结果表明，LT 候选者中 HCV 诱导的 HCC 的下降可能会损害 AFP 模型在最近的 LT 队列中的普遍性。需要进一步的研究来更新或建立更强大的预后模型。