Evidence map›Paper›PMID 40202169›Full record

ArticleBJS open2025

α-Fetoprotein model versus Milan criteria in predicting outcomes after hepatic resection for hepatocellular carcinoma: multicentre study.

Chao Li, Yong-Kang Diao, Yi-Fan Li, Shao-Dong Lv, Xian-Ming Wang, Xue-Dong Wang, Qi-Xuan Zheng, Hong Wang, Han Liu, Kong-Ying Lin and 11 more

Abstract readMulticenter StudyComparative Study
In one paragraph

Article in BJS open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Chao LiDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Yong-Kang DiaoDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Yi-Fan LiDepartment of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, China.
Shao-Dong LvDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Xian-Ming WangDepartment of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
Xue-Dong WangHepatopancreatobiliary Centre, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
Qi-Xuan ZhengDepartment of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
Hong WangDepartment of General Surgery, Liuyang People's Hospital, Liuyang, China.
Han LiuDepartment of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, China.ORCID 0009-0003-6197-5581
Kong-Ying LinDepartment of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, China.
Ying-Jian LiangDepartment of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Ya-Hao ZhouDepartment of Hepatobiliary Surgery, Pu'er People's Hospital, Pu'er, China.
Wei-Min GuFirst Department of General Surgery, Fourth Hospital of Harbin, Harbin, Heilongjiang, China.
Ming-Da WangDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Lan-Qing YaoDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Xin-Fei XuDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Jia-Hao XuDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Li-Hui GuDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Timothy M PawlikDepartment of Surgery, Ohio State University, Wexner Medical Centre, Columbus, Ohio, USA.
Feng ShenDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Tian YangDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.

Funding

Dawn Project Foundation of Shanghai 21SG36National Natural Science Foundation Incubation 2022MS039National Natural Science Foundation of China 82425049Natural Science Foundation of Shanghai 22ZR1477900Shanghai Health and Hygiene Discipline Leader 2022XD001Shanghai Municipal Health Commission 20224Y0299Shanghai Outstanding Academic Leader Programme 23XD1424900Shanghai Science and Technology Committee Rising-Star Programme 22QA1411600
6 · The paper itself

Abstract

backgroundThe Milan criteria and the French α-fetoprotein (AFP) model have both been validated for predicting outcomes after liver transplantation for hepatocellular carcinoma, with the Milan criteria also used for predicting outcomes after hepatic resection. The aim of this study was to evaluate the AFP model's predictive value for recurrence and survival following hepatocellular carcinoma resection and compare its performance with that of the Milan criteria.

methodsData for patients who underwent hepatocellular carcinoma resection between 2002 and 2021 were analysed. For both the AFP model and Milan criteria, patients were divided into two groups: those with hepatocellular carcinoma within and beyond the AFP model (scores ≤ 2 and > 2 points, respectively) and the Milan criteria. Cumulative recurrence and overall survival rates were compared between patients within and beyond the AFP model. Predictions of recurrence and overall survival by the AFP model and Milan criteria were compared using net reclassification improvement and area under the receiver operating characteristic curve analyses.

resultsAmong 1968 patients evaluated, 1058 (53.8%) and 940 (47.8%) were classified as beyond on the AFP model and Milan criteria, respectively. After controlling for competing factors on multivariable analyses, being beyond the AFP model was independently associated with recurrence and worse overall survival after resection of hepatocellular carcinoma. Time-dependent net reclassification improvement and area under the receiver operating characteristic curve analyses demonstrated that the AFP model was superior to the Milan criteria in predicting recurrence. Of note, patients who were classified as beyond both the Milan criteria and AFP model had an even higher risk of postoperative recurrence and mortality (hazard ratios 1.51 and 1.47, respectively).

conclusionThe French AFP model demonstrated superior prognostic accuracy to the Milan criteria in predicting recurrence and survival after hepatocellular carcinoma resection. The AFP model not only effectively stratified patient risk but also identified a subgroup of high-risk patients among those beyond the Milan criteria.

Indexed as

alpha-FetoproteinsCarcinoma, HepatocellularHepatectomyLiver NeoplasmsNeoplasm Recurrence, LocalAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedPredictive Value of TestsPrognosisRetrospective StudiesROC CurveAFP protein, humanalpha-Fetoproteins

Identifiers

PMID40202169
PMCPMC11979696

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.