title: Liver transplantation for hepatocellular carcinoma: further considerations on selection criteria.
abstract: The selection criteria in liver transplantation for HCC are a matter of debate. We reviewed our series, comparing two periods: before and after 1996, when we started to apply the Milan criteria. The study population was composed of patients with a preoperative diagnosis of HCC, confirmed by the pathological report and with a survival of >1 year. Preoperative staging as revealed by radiological imagining was distinguished from postoperative data, including the variable of tumor volume. After 1996 tumor recurrences significantly decreased (6 out of 15 cases, 40% vs. 3 out of 48, 6.3%, P < .005) and 5-year patient survival improved (42% vs. 83%, P < .005). Not meeting the Milan criteria was significantly related to higher recurrence rate (37.5% vs. 12.7%, P < .05) and to lower 5-year patient survival (38% vs. 78%, P < .005%) in the preoperative analysis, but not in the postoperative one. The alfa-fetoprotein level of more than 30 ng/dL and the preoperative tumor volume of more than 28 cm3 predicted HCC recurrences in the univariate and mutivariate analysis (P < .005 and P < .05, respectively). The ROC curve showed a linear correlation between preoperative tumor volume and HCC recurrence. Milan criteria significantly reduced tumor recurrences after liver transplantation, improving long-term survival. In conclusion, the efficacy of tumor selection criteria must be analyzed with the use of preoperative data, to avoid bias of the postoperative evaluation. Tumor volume and alfa-fetoprotein level may improve the selection of patients.
authors.affiliation: Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vetrone
authors.forename: Claudio
authors.initials: C
authors.lastname: Voci
authors.forename: Walter Franco
authors.initials: WF
authors.lastname: Grigioni
authors.forename: Antonia
authors.initials: A
authors.lastname: D'Errico
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ballardini
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavallari
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018579:Patient Selection; D012372:ROC Curve; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis