title: Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging.
abstract: We previously suggested that in patients with heptocellular carcinoma (HCC), the conventional Milan criteria (T1/T2) for orthotopic liver transplantation (OLT) could be modestly expanded based on pathology (UCSF criteria). The present study was undertaken to prospectively validate the UCSF criteria based on pretransplant imaging. Over a 5-year period, the UCSF criteria were used as selection guidelines for OLT in 168 patients, including 38 patients exceeding Milan but meeting UCSF criteria (T3A). The 1- and 5-year recurrence-free probabilities were 95.9% and 90.9%, and the respective survivals without recurrence were 92.1% and 80.7%. Patients with preoperative T1/T2 HCC had 1- and 5-year recurrence-free probabilities of 95.7% and 90.1%, respectively, versus 96.9% and 93.6%, respectively, for preoperative T3A stage (p = 0.58). Under-staging was observed in 20% of T2 and 29% of T3A HCC (p = 0.26). When explant tumor exceeded UCSF criteria (15%), the 1- and 5-year recurrence-free probabilities were 80.4% and 59.5%, versus 98.6% and 96.7%, respectively, for those within UCSF criteria (p < 0.0001). In conclusion, our results validated the ability of the UCSF criteria to discriminate prognosis after OLT and to serve as selection criteria for OLT, with a similar risk of tumor recurrence and under-staging when compared to the Milan criteria.
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. yaofyk@itsa.ucsf.edu
authors.forename: F Y
authors.initials: FY
authors.lastname: Yao
authors.forename: L
authors.initials: L
authors.lastname: Xiao
authors.forename: N M
authors.initials: NM
authors.lastname: Bass
authors.forename: R
authors.initials: R
authors.lastname: Kerlan
authors.forename: N L
authors.initials: NL
authors.lastname: Ascher
authors.forename: J P
authors.initials: JP
authors.lastname: Roberts
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology; D009367:Neoplasm Staging; D018579:Patient Selection; D011336:Probability; D016019:Survival Analysis; D013997:Time Factors