Liver Transpl
, 15 (10), 1278-87
Predicting Recurrence After Liver Transplantation in Patients With Hepatocellular Carcinoma Exceeding the Up-To-Seven Criteria
Francesco D'Amico 1 , Myron Schwartz, Alessandro Vitale, Parissa Tabrizian, Sasan Roayaie, Swan Thung, Maria Guido, Juan del Rio Martin, Thomas Schiano, Umberto Cillo
1 Hepatobiliary Surgery and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, University of Padua, Padua, Italy. drdamico@hotmail.com
DOI: 10.1002/lt.21842
Francesco D'Amico et al. Liver Transpl. Oct 2009
The up-to-seven (Up-to-7) criteria [with 7 being the sum of the size and number of tumors for any given hepatocellular carcinoma (HCC)] have been recently proposed to identify potential candidates for liver transplantation (LT) among patients exceeding the Milan criteria. The aim of this study was to compare the ability of the available pathologic staging systems (the Milan, University of California San Francisco, and Up-to-7 criteria) to predict recurrence. A study population of 479 HCC transplanted patients was identified from prospectively collected databases at Mount Sinai Medical Center (New York, NY) and the University of Padua (Padua, Italy). The best pathologic staging system was identified with log rank, proportion separation index (PSEP), and Cox analyses. Pathologic tumor characteristics (tumor number, tumor size, sum of diameters, macroscopic and microscopic vascular invasion, and grading) were then tested by univariate and multivariate Cox analyses in the prognostic subgroups within and beyond the calculated criteria. The Up-to-7 criteria performed as the best pathologic staging system, the calculated 1-, 3-, and 5-year recurrence probabilities being 4%, 8%, and 14% within the criteria (n = 355) and 22%, 45%, 51% beyond the criteria (n = 124; P < 0.0001) and the calculated PSEP being 0.27 (95% confidence interval = 0.23-0.31). In multivariate analysis, only biological variables (vascular invasion and tumor grade) significantly predicted recurrence beyond the Up-to-7 criteria. A 3-stage pathologic staging system with a potential to be applied in the preoperative setting was thus created: within the Up-to-7 criteria (recurrence rate = 8%), beyond the Up-to-7 criteria without macrovascular invasion and poorly differentiated grade (recurrence rate = 24%), and beyond the Up-to-7 criteria with macrovascular invasion and/or poorly differentiated grade (recurrence rate = 45%). In conclusion, HCC patients within the pathologic Up-to-7 criteria were associated with a low risk of recurrence after LT. Beyond these criteria, however, a significant proportion of patients with a good HCC biological profile had an acceptable risk of recurrence.
Copyright 2009 AASLD
Recurrent Hepatocellular Carcinoma After Transplantation: Use of a Pathological Score on Explanted Livers to Predict Recurrence
JR Parfitt et al. Liver Transpl 13 (4), 543-51. Apr 2007. PMID 17394152.
Milan and University of California at San Francisco (UCSF) criteria are used to select patients with hepatocellular carcinoma (HCC) for liver transplantation (LT). Recurr …
Rate of Tumor Growth Predicts Recurrence of Hepatocellular Carcinoma After Liver Transplantation in Patients Beyond Milan or UCSF Criteria
IA Hanouneh et al. Transplant Proc 43 (10), 3813-8. Dec 2011. PMID 22172852.
Patients with slowly growing tumor who would be currently excluded from LT because tumor burden exceeds traditional Milan and UCSF criteria may have a favorable posttrans …
Liver Transplantation for Hepatocellular Carcinoma Validation of Present Selection Criteria in Predicting Outcome
K Shetty et al. Liver Transpl 10 (7), 911-8. Jul 2004. PMID 15237377.
Appropriate patient selection is crucial in ensuring acceptable outcomes from orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). The United Networ …
Liver Transplantation for Hepatocellular Carcinoma: Beyond the Milan Criteria
FY Yao. Am J Transplant 8 (10), 1982-9. Oct 2008. PMID 18727702. - Review
Liver transplantation represents a cornerstone in the management of early-stage hepatocellular carcinoma (HCC). Expansion beyond the Milan criteria for liver transplantat …
Liver Transplantation for Hepatocellular Carcinoma: Are the Milan Criteria Still Valid?
ME Schwartz et al. Eur J Surg Oncol 34 (3), 256-62. Mar 2008. PMID 18029133. - Review
Liver transplantation (LT) offers excellent results for candidates with hepatocellular carcinoma (HCC) selected according to the Milan criteria. A selection strategy excl …
A Proposal for Modification of the Barcelona Clinic Liver Cancer Staging System Considering the Prognostic Implication of Performance Status
HJ Cho et al. Gut Liver 13 (5), 557-568. 2019. PMID 31023007.
An accurate and relevant staging system for patients with HCC was derived though modification of the BCLC system based on PS.
Accuracy of Pretransplant Imaging Diagnostic for Hepatocellular Carcinoma: A Retrospective German Multicenter Study
U Herden et al. Can J Gastroenterol Hepatol 2019, 8747438. 2019. PMID 30949459.
Selection and prioritization of patients with HCC for LT are based on pretransplant imaging diagnostic, taking the risk of incorrect diagnosis. According to the German wa …
Liver Transplantation for Hepatocellular Carcinoma: Alpha-Fetoprotein Should Be Included in Selection Criteria
HC Pommergaard. Transl Gastroenterol Hepatol 3, 103. 2018. PMID 30701210.
Liver Transplantation for Advanced Hepatocellular Carcinoma: How Far Can We Go?
KS Suh et al. Hepat Oncol 2 (1), 19-28. Jan 2015. PMID 30190984. - Review
Liver transplantation is one of the most effective treatment options for hepatocellular carcinoma. Although the Milan criteria have been widely used to identify suitable …
Recent Advances in Non-Invasive Magnetic Resonance Imaging Assessment of Hepatocellular Carcinoma
D Ippolito et al. World J Gastroenterol 24 (23), 2413-2426. 2018. PMID 29930464. - Review
Magnetic resonance (MR) imaging of the liver is an important tool for the detection and characterization of focal liver lesions and for assessment of diffuse liver diseas …
Carcinoma, Hepatocellular / surgery
Carcinoma, Hepatocellular / therapy *
Liver Neoplasms / surgery
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