title: Beyond the Milan criteria: what risks for patients with hepatocellular carcinoma progression before liver transplantation?
abstract: BACKGROUND
  To date the selection of the best candidates for liver transplantation (LT) owing to hepatocellular carcinoma (HCC) has been mainly based on tumor morphological characteristics (nodule diameter and number), which have resulted to be independent risk factors for short long-term survival and a high rate of tumor recurrence.
  
  
  METHODS
  The study cohort included 118 patients among the 166 with HCC transplanted at our unit from January 2000 to December 2007. Patients were classified according to response to locoregional treatments before LT: progressive Group A; complete Group B; partial Group C; stable Group D.
  
  
  RESULTS
  The 3-year and 5-year overall survival rates were 65.5% and 48.9% for Group A versus 84.8% and 74.6% for Group BCD (P = 0.01). The 3-year and 5-year disease-free survival rates were 74% and 74% for Group A and 95.7% and 93% for Group BCD (P = 0.007). HCC progression was the only independent risk factor according to Cox regression P = 0.014--odds ratio 4.4 (1.35-14.3).
  
  
  CONCLUSIONS
  After aggressive HCC treatment before LT, imaging progression while on the waiting list was a strong predictor of high HCC recurrence rate also in patients who met the Milan criteria. Lack of imaging progression can contribute toward the selection of good transplant candidates for HCC together with the Milan criteria.
authors: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan.
authors: Luciano
authors: L
authors: De Carlis
authors: Stefano
authors: S
authors: Di Sandro
authors: Alessandro
authors: A
authors: Giacomoni
authors: Abdallah
authors: A
authors: Slim
authors: Andrea
authors: A
authors: Lauterio
authors: Iacopo
authors: I
authors: Mangoni
authors: Plamen
authors: P
authors: Mihaylov
authors: Vincenzo
authors: V
authors: Pirotta
authors: Paolo
authors: P
authors: Aseni
authors: Antonio
authors: A
authors: Rampoldi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate