title: Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients listed for HCC with a short waiting time.
abstract: Orthotopic liver transplantation (OLT) indication for hepatocellular carcinoma (HCC) is currently based on the Milan criteria. The University of California, San Francisco (UCSF) recently proposed an expansion of the selection criteria according to tumors characteristics on the explanted liver. This study: 1) assessed the validity of these criteria in an independent large series and 2) tested for the usefulness of these criteria when applied to pre-OLT tumor evaluation. Between 1985 and 1998, 479 patients were listed for liver transplantation (LT) for HCC and 467 were transplanted. According to pre-OLT (imaging at date of listing) or post-OLT (explanted liver) tumor characteristics, patients were retrospectively classified according to both the Milan and UCSF criteria. The 5-yr survival statistics were assessed by the Kaplan-Meier method and compared by the log-rank test. Pre-OLT UCSF criteria were analyzed according to an intention-to-treat principle. Based on the pre-OLT evaluation, 279 patients were Milan+, 44 patients were UCSF+ but Milan- (subgroup of patients that might benefit from the expansion), and 145 patients were UCSF- and Milan-. With a short median waiting time of 4 months, 5-yr survival was 60.1 +/- 3.0%, 45.6 +/- 7.8%, and 34.7 +/- 4.0%, respectively (P < 0.001). The 5-yr survival was arithmetically lower in UCSF+ Milan- patients compared to Milan+ but this difference was not significant (P = 0.10). Based on pathological features of the explanted liver, 5-yr survival was 70.4 +/- 3.4%, 63.6 +/- 7.8%, and 34.1 +/- 3.1%, in Milan+ patients (n = 184), UCSF+ Milan- patients (n = 39), and UCSF- Milan- patients (n = 238), respectively (P < 0.001). However, the 5-yr survival did not differ between Milan+ and UCSF+ Milan- patients (P = 0.33). In conclusion, these results show that when applied to pre-OLT evaluation, the UCSF criteria are associated with a 5-yr survival below 50%. Their applicability is therefore limited, despite similar survival rates compared to the Milan criteria, when the explanted liver is taken into account.
authors.affiliation: Service d'Hépatologie et de Gastroentérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil, France. thomasdecaens@jonline.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Decaens
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: Solange
authors.initials: S
authors.lastname: Hadni-Bresson
authors.forename: Carole
authors.initials: C
authors.lastname: Meyer
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.forename: Francois
authors.initials: F
authors.lastname: Durand
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bernard
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Laurent
authors.initials: L
authors.lastname: Sulpice
authors.forename: Yvon
authors.initials: Y
authors.lastname: Calmus
authors.forename: Jean
authors.initials: J
authors.lastname: Hardwigsen
authors.forename: Christian
authors.initials: C
authors.lastname: Ducerf
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.forename: Sebastien
authors.initials: S
authors.lastname: Dharancy
authors.forename: Olivier
authors.initials: O
authors.lastname: Chazouilleres
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
mesh_terms: D002140:California; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D005260:Female; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012306:Risk; D012495:San Francisco; D016019:Survival Analysis; D016896:Treatment Outcome; D014495:Universities; D014850:Waiting Lists