title: Number and tumor size are not sufficient criteria to select patients for liver transplantation for hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI).
  
  
  METHODS
  From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded.
  
  
  RESULTS
  HCC was confirmed in 168 patients (85.7%). The median follow-up was 74 months. The pathologic findings showed that 106 patients (54.1%) satisfied the Milan criteria, 134 (68.4%) the UCSF criteria of whom 28 (14.3%) were beyond the Milan criteria but within the UCSF criteria, and 34 (17.3%) beyond the UCSF criteria. VI was detected in 41 patients (24%). The 1-, 3-, and 5-year overall survival rates were 90%, 85%, and 77%, respectively, according to the Milan criteria and 90%, 83%, and 76%, respectively, according to the UCSF criteria (P = NS). In univariate and multivariate analyses, tumor size and VI were significant prognostic factors affecting survival (P < 0.001). Two factors were significantly associated with VI: alfa-fetoprotein level of >400 ng/ml and tumor grade G3.
  
  
  CONCLUSIONS
  Tumor size and VI were the only significant prognostic factors affecting survival of HCC patients. Primary liver resection could be a potential selection treatment before LT.
authors.affiliation: Pôle de Pathologie Digestive, Hépatique et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
authors.forename: T
authors.initials: T
authors.lastname: Piardi
authors.forename: F
authors.initials: F
authors.lastname: Gheza
authors.forename: B
authors.initials: B
authors.lastname: Ellero
authors.forename: M L
authors.initials: ML
authors.lastname: Woehl-Jaegle
authors.forename: D
authors.initials: D
authors.lastname: Ntourakis
authors.forename: M
authors.initials: M
authors.lastname: Cantu
authors.forename: E
authors.initials: E
authors.lastname: Marzano
authors.forename: M
authors.initials: M
authors.lastname: Audet
authors.forename: P
authors.initials: P
authors.lastname: Wolf
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor