title: Expanded criteria for liver transplantation in patients with cirrhosis and hepatocellular carcinoma.
abstract: Orthotopic liver transplantation (OLT) selection for patients with hepatocellular carcinoma (HCC) is a matter of debate. The Milan criteria (MC) have been largely adopted by the international community. The main aim of this study was to evaluate the survival rates and recurrence probabilities of a new proposal for criteria (up to 3 tumors, each no larger than 5 cm, and a cumulative tumor burden </= 10 cm). Patients with cirrhosis and HCC included on the waiting list (WL) from 1991 to 2006 were retrospectively analyzed. Outcomes in patients who had tumors within and beyond the MC were compared. The survival analysis was done (1) with the intention-to-treat principle and (2) among transplanted patients. A total of 281 patients were included in WL. Twenty-four cases did not undergo OLT (a dropout rate of 8.5%); all but 1 case had tumors within the MC. Of the 257 transplanted patients, 26 had tumors beyond the MC in the pre-OLT evaluation. Based on the intention-to-treat analysis, the 5-year survival was 56% versus 66% in patients who had tumors within and beyond the MC, respectively (P = 0.487). Among transplanted patients, the 5-year survival was 62% versus 69%, respectively (P = 0.734). Through multivariate analysis, microvascular invasion was an independent prognostic factor of poor survival (P = 0.004). The recurrence probabilities at 1 and 5 years were 7% versus 12% and 14% versus 28% in patients with tumors within and beyond the MC, respectively (P = 0.063). The multivariate analysis demonstrated that both poorly differentiated tumors (P < 0.001) and microvascular invasion (P < 0.001) increased the risk of recurrence. The expansion to up to 3 nodules, each up to 5 cm, and a cumulative tumor burden </= 10 cm did not result in a reduction of survival in comparison with patients who had tumors within the MC.
authors.affiliation: Department of Hepatogastroenterology, Hospital Universitario La Fe, Valencia, Spain. mauriciosilva11@yahoo.com.br
authors.forename: Mauricio
authors.initials: M
authors.lastname: Silva
authors.forename: Angel
authors.initials: A
authors.lastname: Moya
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
authors.forename: Fernando
authors.initials: F
authors.lastname: Sanjuan
authors.forename: Rafael
authors.initials: R
authors.lastname: López-Andujar
authors.forename: Eugenia
authors.initials: E
authors.lastname: Pareja
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Torres-Quevedo
authors.forename: Victoria
authors.initials: V
authors.lastname: Aguilera
authors.forename: Eva
authors.initials: E
authors.lastname: Montalva
authors.forename: Manuel
authors.initials: M
authors.lastname: De Juan
authors.forename: Angelo
authors.initials: A
authors.lastname: Mattos
authors.forename: Martín
authors.initials: M
authors.lastname: Prieto
authors.forename: José
authors.initials: J
authors.lastname: Mir
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology