title: Downstaging advanced hepatocellular carcinoma to the Milan criteria may provide a comparable outcome to conventional Milan criteria.
abstract: OBJECTIVE
  Many hepatocellular carcinoma (HCC) patients met the appropriate criteria and accepted liver transplantation after successful downstaging therapies; however, the outcome in these patients is unclear. We aim to compare the outcome of patients meeting the Milan criteria at the beginning and after successful downstaging therapies.
  
  
  METHODS
  Between July 2001 and January 2013, 112 patients were diagnosed with early-stage HCC that met the Milan criteria. Of these patients, 58 patients did not meet the Milan criteria initially but did after successful downstaging therapies. We retrospectively collected and then compared the baseline characteristics, postoperative complications, survival rate, and tumor recurrence rate of these two groups. Kaplan-Meier analyses were used to estimate the long-term overall survival and tumor-free survival in these patients.
  
  
  RESULTS
  No significant differences were observed between the two groups with respect to baseline donor and recipient characteristics. The downstaging Milan group showed similar tumor characteristics compared to the conventional Milan group, except the downstaging group had better tumor histopathologic grading (P = 0.027). The 1-, 3-, and 5-year overall survival rates were comparable at 91.4, 82.8, and 70.7 %, respectively, in the downstaging Milan criteria and 92.0, 85.7, and 74.1 %, respectively, according to the initial Milan criteria (P = 0.540). The 1-, 3-, and 5-year tumor-free survival rates between the two groups were not statistically significant (P = 0.667).
  
  
  CONCLUSIONS
  Successful downstaging therapies can provide a comparable posttransplantation overall survival and tumor-free survival rates after liver transplantation.
authors.affiliation: Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, 610041, China. leijianyong11@163.com
authors.forename: Jianyong
authors.initials: J
authors.lastname: Lei
authors.forename: Wentao
authors.initials: W
authors.lastname: Wang
authors.forename: Lunan
authors.initials: L
authors.lastname: Yan
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D016634:Radiosurgery; D012189:Retrospective Studies; D015996:Survival Rate