title: Importance of Screening for Esophagogastric Varices in Naïve Hepatocellular Carcinoma Patients within Milan Criteria: Indicator for Liver Transplantation.
abstract: OBJECTIVE
  Patients with hepatocellular carcinoma (HCC) beyond Milan criteria (MC) are not eligible for liver transplantation (LT). To elucidate prognostic factors significantly linked to recurrence beyond MC or death related to the liver, we evaluated the clinical features in a series of HCC patients within MC at baseline.
  
  
  METHODS
  We enrolled 255 naïve HCC patients (≤70 years) within the MC who underwent upper-gastrointestinal-endoscopy, and were treated with resection or radiofrequency ablation (62 years old [median]; male:female = 202:53; Child-Pugh A:B = 216:39). A finding of esophagogastric varices (EGV) with an enlarged tortuous or coil shape, and past history of treatment for EGV were classified as clinically significant.
  
  
  RESULTS
  Following curative therapy, there was a significant difference for both 3- and 5-year rates of recurrence beyond the MC or liver-related death between the patients with and without significant-EGV (42.8 and 64.3% vs. 25.2 and 41.2%, respectively; p < 0.001). Positive for significant-EGV, multiple tumor, and elevated levels of fucosylated-alpha-fetoprotein (≥10%) and des-gamma-carboxy-prothrombin (≥100 mAU/mL) were significant prognostic factors for recurrence beyond the MC or liver-related death in multivariate analysis (hazard ratio [HR] 2.020, p = 0.002; HR 1.880, p = 0.005; HR 1.626, p = 0.045; HR 1.722, p = 0.011, respectively).
  
  
  CONCLUSIONS
  LT should be considered for EGV-positive patients with naïve HCC and within the MC.
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Kawakami
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery*; D017115:Catheter Ablation; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications*; D016031:Liver Transplantation / Q000592:standards; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012189:Retrospective Studies; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: Esophagogastric varices; Hepatocellular carcinoma; Liver transplantation; Milan criteria; Portal hypertension