RT Journal Article
SR Electronic
T1 Liver transplantation for hepatocellular carcinoma beyond the Milan criteria
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 1035
OP 1041
DO 10.1136/gutjnl-2014-308513
VO 65
IS 6
A1 Xiao Xu
A1 Di Lu
A1 Qi Ling
A1 Xuyong Wei
A1 Jian Wu
A1 Lin Zhou
A1 Sheng Yan
A1 Liming Wu
A1 Lei Geng
A1 Qinghong Ke
A1 Feng Gao
A1 Zhenhua Tu
A1 Weilin Wang
A1 Min Zhang
A1 Yan Shen
A1 Haiyang Xie
A1 Wenshi Jiang
A1 Haibo Wang
A1 Shusen Zheng
YR 2016
UL http://gut.bmj.com/content/65/6/1035.abstract
AB Objective Liver transplantation is an optimal radical therapy for selected patients with hepatocellular carcinoma. The stringent organ allocation system driven by the Milan criteria has been challenged by alternative sets of expanded criteria. Careful analysis is needed to prove that the Milan criteria can be expanded safely and effectively.Design This study collectively reviewed 6012 patients of hepatocellular carcinoma from the China Liver Transplant Registry. Expanded criteria were evaluated to characterise an optimised expansion with acceptable outcomes beyond the Milan criteria.Results Compared with the Milan criteria, Valencia, University of California, San Francisco, University Clinic of Navarra and Hangzhou criteria provided an expansion of 12.4%, 16.3%, 19.6%, and 51.5%, respectively. The post-transplant survivals of patients fulfilling the expanded criteria were comparable to that of the Milan criteria. The analysis of net reclassification improvement and area under the receiver operating characteristic curves showed an excellent efficiency in recurrence prediction for the expanded criteria compared with the Milan criteria. In patients exceeding Milan but fulfilling the Hangzhou criteria (N=1352), α-fetoprotein (AFP) >100 ng/mL and tumour burden>8 cm were the only two independent prognostic factors (p<0.001). Accordingly, the Hangzhou criteria were stratified as type A (tumour burden ≤8 cm, or tumour burden >8 cm but AFP≤100 ng/mL) and type B (tumour burden >8 cm but AFP between 100 and 400 ng/mL). Type A showed significantly higher 5-year tumour-free survival rates compared with type B (p<0.001).Conclusions The Milan criteria can be expanded safely and effectively. The prognostic stratification system based on the Hangzhou criteria serves as a hierarchy of transplant candidates for hepatocellular carcinoma.