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  • Enhancing Recurrence-Free Survival Prediction in Hepatocellular Carcinoma: A Time-Updated Model Incorporating Tumor Burden and AFP Dynamics.
    Publication . Akabane, Miho; Kawashima, Jun; Altaf, Abdullah; Woldesenbet, Selamawit; Cauchy, François; Aucejo, Federico; Popescu, Irinel; Kitago, Minoru; Martel, Guillaume; Ratti, Francesca; Aldrighetti, Luca; Poultsides, George A; Imaoka, Yuki; Ruzzenente, Andrea; Endo, Itaru; Gleisner, Ana; Pinto Marques, Hugo; Oliveira, Sara; Balaia, Jorge; Lam, Vincent; Hugh, Tom; Bhimani, Nazim; Shen, Feng; Pawlik, Timothy M
    Background: Existing models to predict recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on static preoperative factors such as alpha-fetoprotein (AFP) and tumor burden score (TBS). These models overlook dynamic postoperative AFP changes, which may reflect evolving recurrence risk. We sought to develop a dynamic, real-time model integrating time-updated AFP values with TBS for improved recurrence prediction. Patients and methods: Patients undergoing curative-intent hepatectomy for HCC (2000-2023) were identified from an international, multi-institutional database with RFS as the primary outcome. AFP trajectory was monitored from preoperative to 6- and 12-month postoperative values, using time-varying Cox regression with AFP as a time-dependent covariate. The predictive accuracy of this time-updated model was compared with a static preoperative Cox model excluding postoperative AFP. Results: Among 1911 patients, AFP trajectories differed between recurrent and nonrecurrent cases. While preoperative AFP values were similar, recurrent cases exhibited higher AFP at 6 and 12 months. Multivariable analysis identified TBS (hazard ratio (HR):1.043 [95% confidence interval (CI): 1.002-1.086]; p = 0.039) and postoperative log AFP dynamics (HR:1.216 [CI 1.132-1.305]; p < 0.001) as predictors. Contour plots depicted TBS's influence decreasing over time, while postoperative AFP became more predictive. The time-varying Cox model was created to update RFS predictions continuously on the basis of the latest AFP values. The preoperative Cox model, developed with age, AFP, TBS, and albumin-bilirubin score, had a baseline C-index of 0.61 [0.59-0.63]. At 6 months, the time-varying model's C-index was 0.70 [0.67-0.73] versus 0.59 [0.56-0.61] for the static model; at 12 months, it was 0.70 [0.66-0.73] versus 0.56 [0.53-0.59]. The model was made available online ( https://nm49jf-miho-akabane.shinyapps.io/AFPHCC/ ). Conclusions: Incorporating postoperative AFP dynamics into RFS prediction after HCC resection enhanced prediction accuracy over time, as TBS's influence decreased. This adaptive, time-varying model provides refined RFS predictions throughout follow-up.
    2025-08Text Open access Show more
  • Balloon Atrioseptostomy for Transposition of the Great Arteries in Europe: Characteristics and Outcomes.
    Publication . Lucron, Hugues; Malekzadeh-Milani, Sophie-Guiti; de Montclos, Thomas Perouse; Baruteau, Alban-Elouen; Mendoza Soto, Alberto; Butera, Gianfranco; Michel-Behnke, Ina; Ovaert, Caroline; Bautista-Rodriguez, Carles; Bentham, James; Jalal, Zakaria; Betrian Blasco, Pedro; Bouvaist, Hélène; Vincenti, Marie; Ferreira Matins, José Diego; Jellimann, Jean-Marc; Callegari, Alessia; Bonnemains, Laurent; Bonnefoy, Ronan; Castaldi, Biagio; Charbonneau, Anne; Dauphin, Claire; Lefort, Bruno; Schubert, Stephan; Brard, Mélanie; Domanski, Olivia; Denis, Charlotte; Wacker, Julie; Maragnes, Pascale; Karsenty, Clément; Loureiro, Petra; Jakob, André; Hascoët, Sébastien; Bonnet, Damien
    Introduction and objectives: Balloon atrial septostomy (BAS) improves oxygenation in neonates with transposition of the great arteries (TGA) and restrictive foramen ovale. Currently, there is a global shortage of dedicated BAS catheters, while new unmarked catheters have recently become available at some European centers. This study aimed to characterize BAS outcomes using the currently available BAS catheters in Europe. Methods: A 2-year multicenter observational registry was conducted, including all neonates undergoing BAS for TGA. We report preliminary results (September 2022-February 2024) focusing on BAS characteristics and outcomes. Results: A total of 250 BAS procedures were performed in 29 centers. The median neonatal weight was 3.16kg, and 88% of neonates had a prenatal diagnosis. Most procedures were performed often on the first day of life during working hours (72.8%), mainly in catheterization laboratories (59.2%). Guidance primarily involved ultrasound with or without fluoroscopy. A guidewire was used in 41.2% of procedures. A total of 290 catheters (286 Z-5 or Z-6) were used, achieving an overall BAS success rate of 96%. Complete procedural failure was associated with the use of the umbilical venous route (OR, 3.62; P=.001) and lower-volume catheters (OR, 7.01; P<.001). The occurrence of significant complications (8%; OR, 9.33; P<.001) was associated with complete procedural failure. For complex procedures, significant risk factors were the absence of fluoroscopy (OR, 3.32; P=.001), use of the umbilical venous route (OR, 2.28; P=.005), and lower-volume catheters (OR, 2.43; P=.03). Conclusions: In the current era, BAS can be challenging, and significant complications and complete failures are not uncommon. The use of the umbilical venous route, low-volume BAS catheters, absence of fluoroscopy guidance, and the occurrence of complications negatively impact procedural outcomes.
    2025-08Text Open access Show more