Skip to main content
SpringerLink
Log in

Prognosis of Liver Transplantation for Hepatocellular Carcinoma in Terms of Different Criteria: A Single Center Experience

  • Published:
Current Medical Science Aims and scope Submit manuscript

Abstract

Objective

Patients undergoing liver transplantation for hepatocellular carcinoma (HCC) within the Milan criteria have an excellent outcome. We developed a program to analyze and prove that the Milan criteria can be expanded safely and effectively.

Methods

We retrospectively reviewed 117 HCC patients treated with liver transplantation between January 2013 and December 2017. Patients were grouped according to the Milan criteria, the University of California, San Francisco (UCSF) criteria, Up-to-seven criteria and Hangzhou criteria. Tumor-free and overall survival rates were investigated with a Kaplan-Meier analysis. Multivariable regression Cox models produced survival estimates for the patients that exceeded the Milan criteria.

Results

The 1-year, 3-year and 5-year overall survival rates of patients fulfilling the Milan criteria (n=44) were 100%, 87.5% and 78.9%, respectively. Compared with the Milan criteria, the UCSF criteria (n=50), Up-to-seven criteria (n=51) and Hangzhou criteria (n=86) provided an expansion of 13.6%, 15.9% and 95.9%, respectively. The 1-year, 3-year and 5-year overall survival rates of patients fulfilling UCSF criteria, Up-to-seven criteria and Hangzhou criteria were 96.0%, 84.9%, 76.9%; 96.1%, 85.2%, 77.6% and 97.7%, 83.9%, 66.7%, respectively (P>0.05). Multifactor Cox regression showed that tumor diameter and microvascular invasion were independent risk factors for survival in patients that exceeded the Milan criteria.

Conclusion

Compared with the Milan criteria, the Hangzhou criteria can safely expand the scope of liver transplantation for HCC to a certain extent. By contrast, the UCSF criteria and Up-to-seven criteria result in a limited number of patients which need further expansion. Tumor diameter and microvascular invasion were the independent risk factors for survival in patients that exceeded the Milan criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018,68(6):394–424

    PubMed  Google Scholar 

  2. Wang FS, Fan JG, Zhang Z, et al. The global burden of liver disease: The major impact of China. Hepatology, 2014,60(6):2099–2108

    Article  Google Scholar 

  3. Ofosu A, Gurakar A. Current concepts in hepatocellular carcinoma and liver transplantation: a review and 2014 update. Euroasian J Hepatogastroenterol, 2015,5(1):19–25

    Article  Google Scholar 

  4. Aravinthan AD, Bruni SG, Doyle AC, et al. Liver transplantation is a preferable alternative to palliative therapy for selected patients with advanced hepatocellular carcinoma. Ann Surg Oncol, 2017,24(7):1843–1851

    Article  Google Scholar 

  5. Kaido T. Selection criteria and current issues in liver transplantation for hepatocellular carcinoma. Liver Cancer, 2016,5(2):121–127

    Article  CAS  Google Scholar 

  6. Pavel MC, Fuster J. Expansion of the hepatocellular carcinoma Milan criteria in liver transplantation: Future directions. World J Gastroenterol, 2018,24(32):3626–3636

    Article  Google Scholar 

  7. Kaido T. Selection criteria and current issues in liver transplantation for hepatocellular carcinoma. Liver Cancer, 2016,5(2):121–127

    Article  CAS  Google Scholar 

  8. Mancuso A, Perricone G. Hepatocellular carcinoma and liver transplantation: state of the art. J Clin Transl Hepatol, 2014,2(3):176–181

    PubMed  PubMed Central  Google Scholar 

  9. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med, 1996,334(11):693–699

    Article  CAS  Google Scholar 

  10. Gunsar F. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria. Exp Clin Transplant, 2017,15(Suppl 2):59–64

    PubMed  Google Scholar 

  11. Fan J, Yang GS, Fu ZR, et al. Liver transplantation outcomes in 1078 hepatocellular carcinoma patients: a muticenter experience in Shanghai, China. J Cancer Res Clin Oncol, 2009,135(10):1403–1412

    Article  Google Scholar 

  12. Cascales-Campos P, Martinez-Insfran LA, Ramirez P, et al. Liver Transplantation in Patients With Hepatocellular Carcinoma Outside the Milan Criteria After Downstaging: Is It Worth It?. Transplant Proc, 2018,50(2):591–594

    Article  CAS  Google Scholar 

  13. Lingiah VA, Niazi M, Olivo R, et al. Liver Transplantation Beyond Milan Criteria. J Clin Transl Hepatol, 2020,8(1):69–75

    Article  Google Scholar 

  14. Commander SJ, Shaw B, Washburn L, et al. A long-term experience with expansion of Milan criteria for liver transplant recipients. Clin Transplant, 2018,32(6):e13254

    Article  Google Scholar 

  15. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology, 2001,33(6):1394–1403

    Article  CAS  Google Scholar 

  16. Duffy JP, Vardanian A, Benjamin E, et al. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-yearexperience with 467 patients at UCLA. Ann Surg, 2007,246(3):502–509

    Article  Google Scholar 

  17. Mazzaferro V, Llovet JM, Miceli R, et al. Metroticket Investigator Study Group. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol, 2009,10(1):35–43

    Article  Google Scholar 

  18. Zheng SS, Xu X, Wu J, et al. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplantation, 2008,85(12):1726–1732

    Article  CAS  Google Scholar 

  19. Qu Z, Ling Q, Gwiasda J, et al. Hangzhou criteria are more accurate than Milan criteria in predicting long-term survival after liver transplantation for HCC in Germany. Langenbecks Arch Surg, 2018,403(5):643–654

    Article  Google Scholar 

  20. Lei JY, Wang WT, Yan LN. Hangzhou criteria for liver transplantation in hepatocellular carcinoma: a single-center experience. Eur J Gastroenterol Hepatol, 2014,26(2):200–204

    Article  CAS  Google Scholar 

  21. Guerrini GP, Pinelli D, Di Benedetto F, et al. Predictive value of nodule size and differentiation in HCC recurrence after liver transplantation. Surg Oncol, 2016,25(4):419–428

    Article  Google Scholar 

  22. Polat KY, Acar S, Gencdal G, et al. Hepatocellular Carcinoma and Liver Transplantation: A Single-Center Experience. Transplant Proc, 2020,52(1):259–264

    Article  Google Scholar 

  23. Soriano A, Varona A, Gianchandani R, et al. Selection of patients with hepatocellular carcinoma for liver transplantation: past and future. World J Hepatol, 2016,8(1):58–68

    Article  Google Scholar 

  24. Xu X, Lu D, Ling Q, et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria. Gut, 2016,65(6):1035–1041

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China

    Shao-cheng Lyu, Jing Wang, Zhang-yong Ren, Di Cao & Qiang He

Authors
  1. Shao-cheng Lyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhang-yong Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Di Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qiang He
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qiang He.

Additional information

Conflict of Interest Statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lyu, Sc., Wang, J., Ren, Zy. et al. Prognosis of Liver Transplantation for Hepatocellular Carcinoma in Terms of Different Criteria: A Single Center Experience. CURR MED SCI 42, 548–554 (2022). https://doi.org/10.1007/s11596-022-2558-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-022-2558-8

Key words

Search

Navigation