title: Applicability of the Milan criteria for determining liver transplantation as a first-line treatment for hepatocellular carcinoma.
abstract: BACKGROUND
  To determine whether or not the Milan criteria (MC) should be used to determine the applicability of liver transplantation (LT) as a first-line treatment for patients with cirrhosis with hepatocellular carcinoma (HCC) who are able to endure hepatectomy.
  
  
  METHODS
  Retrospective analysis of 82 patients with cirrhosis with HCC who were treated by hepatectomy without LT at our institution between 1990 and 2003.
  
  
  RESULTS
  Of these 82 patients, 48 met the MC. Proportional hazard regression analyses to determine the independent prognostic factors for postoperative cumulative patient and disease-free survival showed that meeting the MC is the strongest prognostic factor for both patient and disease-free survival. The cumulative patient and disease-free survival rates were 76.7% and 28.9%, respectively, at 5 years in patients who met the MC. The cumulative disease-free survival was markedly inferior to those in previously reported series of LT for HCC who met the MC, but the cumulative patient survival was comparable to those in the previously reported series. A comparison of cumulative postoperative survival between patients who met the MC and fulfilled all five factors listed below and patients who met the MC but did not fulfill any of the five factors demonstrated that the latter patients showed statistically significantly worse postoperative patient survival than the former. The five factors included: Model for End-Stage Liver Disease score < 10, indocyanine green retention rate at 15 minutes < 20%, absence of microscopic fibrous capsular invasion and microscopic intrahepatic metastases, and earlier grade (T1 or T2) of American Joint Committee on Cancer tumor classification.
  
  
  CONCLUSIONS
  The MC should not be used to determine the applicability of LT as a first-line treatment for patients with HCC considered able to endure hepatectomy. However, modifying MC with some clinicopathological factors could satisfy the appropriate criteria for applying LT as a first-line treatment for these patients.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takeda
authors.forename: Michio
authors.initials: M
authors.lastname: Ueda
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Sugita
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekido
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000628:therapy* / Q000821:virology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy* / Q000821:virology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate