Liver transplantation for hepatocellular carcinoma in patients who do not meet the Milan criteria.
BACKGROUND
To expand the Milan criteria, prognostic factors other than size and number of tumor may be necessary. We analyzed outcome and prognostic factors in patients with hepatocellular carcinoma (HCC) exceeding Milan criteria to select favorable group of patients.


METHODS
Between November 1997 and December 2005, 104 cases of liver transplantation for patients with HCC were performed at our center. Twenty-four patients did not meet the Milan criteria preoperatively. Among these 24 patients, 19 had no major vascular invasion at the time of surgery. We analyzed the survival and prognostic factors of these 19 patients. The mean follow-up period was 33 months (range 6-89).


RESULTS
Three-year survival rate in 19 patients was 67.4%. Three-year survival rates were significantly higher when preoperative alpha-fetoprotein was less than 400 ng/ml (86.2 vs. 0%, p<0.001) when Edmonson-Steiner's histological grade 1 or 2 (100 vs. 40%, p = 0.036) and when microvascular invasion was absent (78.6 vs. 30%, p = 0.039).


CONCLUSIONS
If vascular invasion is absent in preoperative radiological studies, and the preoperative alpha-fetoprotein is less than 400 ng/ml, our findings suggest a good prognosis after liver transplantation for HCC patients who do not meet the Milan criteria.
Suh
Kyung-Suk
KS
Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea. kssuh@plaza.snu.ac.kr
Cho
Eung-Ho
EH
Lee
Hae Won
HW
Shin
Woo Young
WY
Yi
Nam-Joon
NJ
Lee
Kuhn Uk
KU
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010560:Personnel Selection; D011379:Prognosis; D016019:Survival Analysis; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins