title: Predictive factors of downstaging of hepatocellular carcinoma beyond the Milan criteria treated with intra-arterial therapies.
abstract: OBJECTIVE
  This study was designed to analyze the clinical results in patients suitable for liver transplantation with hepatocellular carcinoma (HCC) who exceeded Milan criteria, which underwent intra-arterial therapies (IAT), to determine predictive factors of successful downstaging.
  
  
  METHODS
  A total of 277 consecutive patients with cirrhosis and HCC were treated by IAT (transarterial oily chemoembolization, transarterial chemoembolization, transarterial embolization) in a single center. Eighty patients exceed the Milan criteria. Patients with infiltrative HCC, hypovascular HCC, and portal vein thrombosis were excluded, with a final study population of 48 patients. Tumor response to IAT was evaluated with CT and/or MRI according to modified RECIST criteria. Successful downstaging was defined as a reduction in the number and size of viable tumors to within the Milan criteria, and serum alpha-fetoprotein (AFP) <100 ng/mL, for at least 6 months.
  
  
  RESULTS
  Nineteen patients (39 %) had their tumors successfully downstaged; 29 patients (61 %) did not. Multivariate analysis showed that AFP level <100 ng/mL and 3-year calculated survival probability using the Metroticket calculator were the only independent predictors of successful downstaging (p < 0.023 and p < 0.049 respectively).
  
  
  CONCLUSIONS
  Biological characteristics of HCC as AFP levels <100 ng/mL and high 3-year calculated survival probability may predict a good response to downstage after IAT.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, (ISMETT), Via Tricomi 1, 90100, Palermo, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Bova
authors.forename: Roberto
authors.initials: R
authors.lastname: Miraglia
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Vizzini
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D016009:Chi-Square Distribution; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009367:Neoplasm Staging; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D014283:Triiodobenzoic Acids; C064572:gadobenic acid; D007472:Iohexol; D008536:Meglumine; C038192:iopromide; C044834:iodixanol