Journal of Gastrointestinal Surgery

, Volume 17, Issue 6, pp 1116–1122 | Cite as

Outcome Comparisons Among the Hangzhou, Chengdu, and UCSF Criteria for Hepatocellular Carcinoma Liver Transplantation after Successful Downstaging Therapies

Original Article

Abstract

Background

In Mainland China, many selection criteria for hepatocellular carcinoma (HCC) liver transplantation, such as the Hangzhou, the Chengdu, and the Fudan criteria, have been established. No comparisons have been made among the outcomes using the Hangzhou, Chengdu, and University of California, San Francisco (UCSF) criteria in patients who underwent successful downstaging therapies.

Methods

After successful downstaging therapies, 72 patients met the UCSF criteria, 86 met the Chengdu criteria, and 102 met the Hangzhou criteria. The data on these HCC patients were retrospectively analyzed, and various outcomes, such as survival and the tumor-free survival rate, were compared among the three groups.

Results

No significant differences were observed among the three groups with regard to the downstaging protocols, baseline characteristics, or liver function. However, the patients who met the Hangzhou criteria had significantly larger tumor targets than those who met the Chengdu or UCSF criteria (P < 0.05). The three groups showed similar 1-, 3-, and 5-year survival rates (90.9, 80.0, and 78.6 %, respectively, for the UCSF criteria; 91.6, 81.9, and 75.6 %, respectively, for the Hangzhou criteria; and 91.1, 83.3, and 79.4 %, respectively, for the Chengdu criteria); 1-, 3-, and 5-year tumor-free survival rates (83.3, 77.5, and 75 %, respectively, for the UCSF criteria; 86.3, 78.8, and 75.6 %, respectively, for the Hangzhou criteria; and 87.3, 79.2, and 76.4 %, respectively, for the Chengdu criteria); and 1-, 3-, and 5-year tumor recurrence rates (9.2, 17.5, and 21.4 %, respectively, for the UCSF criteria; 8.4, 16.4, and 20 % for the Hangzhou criteria; and 8.9, 14.6, and 17.6 % for the Chengdu criteria).

Conclusion

Because they have contributed to similar outcomes but to larger HCC patient pools, the Hangzhou criteria for HCC transplantation should be comprehensively accepted in China for HCC patients after successful downstaging therapies.

Keywords

Criteria Liver Transplantation Downstage 

Abbreviations

HCC

Hepatocellular carcinoma

LT

Liver transplantation

TACE

Transcatheter arterial chemoembolization

RAF

Radiofrequency ablation

HIFU

High-intensity focused ultrasound

AFP

Alpha-fetoprotein

LDLT

Living donor liver transplantation

DDLT

Deceased donor liver transplantation

HBIG

Hepatitis B immunoglobulin

Anti-HBs

Hepatitis B surface antigen

BMI

Body mass index

LD

Liver disease

TNM

Tumor–node–metastasis

OLT

Orthotopic liver transplantation

UNOS

United Network for Organ Sharing

UCSF

University of California, San Francisco

References

  1. 1.
    Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzrtti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693-9[PMID:8594428]PubMedCrossRefGoogle Scholar
  2. 2.
    Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;6:1394-1403 [PMID:11391528]CrossRefGoogle Scholar
  3. 3.
    Roayaie S, Frischer JS, Emre SH, Fishbein TM, Sheiner PA, Sung M, et al. Long-term results with multi-modal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters. Ann Surg. 2002;235:533-539 [PMID:11923610]PubMedCrossRefGoogle Scholar
  4. 4.
    Zheng SS, Xu X, Wu J, Chen J, Wang WL, Zhang M, et al. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplantation 2008;85: 1726-1732 [PMID:18580463]PubMedCrossRefGoogle Scholar
  5. 5.
    Hanouneh IA, Macaron C, Lopez R, Aucejo F, Zein NN. Rate of tumor growth predicts recurrence of hepatocellular carcinoma after liver transplantation in patients beyond Milan or UCSF criteria. Transplant Proc. 2011 Dec;43(10):3813-8 [PMID:22172852]Google Scholar
  6. 6.
    Parkin M, Bray F, Ferlay J, Pisani P. Global cancer statistics. 2002.CA Cancer J. Clin. 2005;55:74-108 [PMID:15761078]PubMedCrossRefGoogle Scholar
  7. 7.
    Lei JY, Yan LN. Comparison between living donor liver transplantation recipients who met the Milan and UCSF criteria after successful down-staging therapies. J Gastrointest Surg. 2012 Sep 5[Epud ahead of print] [PMID:22948843]Google Scholar
  8. 8.
    Jiang L, Yan L, Li B, Wen T, Zhao J, Jiang L, et al. Prophylaxis against hepatitis B recurrence posttransplantation using lamivudine and individualized low-dose hepatitis B immunoglobulin. Am J Transplant.2010 Aug;10(8):1861-9 [PMID:20659092]Google Scholar
  9. 9.
    Iwatsuki S, Starzl TE, Sheahan FG, Yokohama I, Demetris AJ, Todo S, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 1991;214:221-228 [PMID: 1656903]PubMedCrossRefGoogle Scholar
  10. 10.
    Bismuth H, Chiche L, Adan R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation in cirrhotic patients with hepatocellular carcinoma in cirrhosis. Ann Surg 1993;218:145-151 [PMID:8393649]PubMedCrossRefGoogle Scholar
  11. 11.
    International Union Against Cancer (UICC). TNM Classification of Malignant Tumors. 5th ed. In: LH Sobin, Ch Wittekind (eds). New York, NY: Wiley-Liss,1997:74-77Google Scholar
  12. 12.
    Marsh JW, Dvorchik I, Bonham CA, Iwatsuki S. Is the pathologic TNM staging system for patients with hepatoma predictive of outcome? Cancer 2000;88:538-543 [PMID:10649244]PubMedCrossRefGoogle Scholar
  13. 13.
    Yao FY, Ferrell L, Bass NM, Bacchetti P, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria. Liver Transpl.2002 Sep;8(9):765-74 [PMID:12200775]Google Scholar
  14. 14.
    Duffy JP, Vardanian A, Benjamin E, Watson M, Farmer DG, Ghobrial RM, et al. Liver transplantation criteria for hepatocellular should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg. 2007 Sep; 246(3):502-9 [PMID:17717454]Google Scholar
  15. 15.
    Fouzas I, Sotiropoulos GC, Lang H, Nadalin S, Beckebaum S, Sgourakis G, et al. Living donor liver transplantation for hepatocellular carcinoma in patients exceeding the UCSF criteria. Transplant Proc.2008 Nov;40(9):3185-8 [PMID:19010228]Google Scholar
  16. 16.
    Macaron C, Hanouneh IA, Lopez R, Aucejo F, Zein NN. Total tumor volume predicts recurrence of hepatocellular carcinoma after liver transplantation in patients beyond Milan or UCSF criteria. Transplant Proc.2010 Dec;42(10):4585-92 [PMID:21168743]Google Scholar
  17. 17.
    Yao FY, Kinkhabwala M, LaBerge JM, Bass NM, Brown R Jr, Kerlan R, et al. The impact of preoperative loco-regional therapy on outcome after liver transplantation for hepatocellular carcinoma. Am J Transplant. 2005;5:795-804 [PMID:15760404]PubMedCrossRefGoogle Scholar
  18. 18.
    Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, et al. Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transpl 2008;8:2547-2557 [PMID:19032223]CrossRefGoogle Scholar
  19. 19.
    Chapman WC, Doyle MB, Stuart JE, Vachharajani N, Crippin JF, Anderson CD, et al. Outcomes of neoadjuvant transarterial chemoembolization to down-stage hepatocellular carcinoma before liver transplantation. Ann Surg 2008;248:617-625 [PMID:18936575]PubMedGoogle Scholar
  20. 20.
    Silva MF, Sherman M. Criteria for liver transplantation for HCC: What should the limits be? Journal of Hepatology. 2011, 55:1137-1147 [PMID:21718672]PubMedCrossRefGoogle Scholar
  21. 21.
    Suh KS, Cho EH, Lee HW, Chin WY, Yi NJ, Lee KU. Liver transplantation for hepatocellular carcinoma in patients who do not meet the Milan criteria. Dig Dis 2007;25:329-333 [PMID:17960068]PubMedCrossRefGoogle Scholar
  22. 22.
    Cillo U, Vitale A, Grigoletto F, Gringeri E, D’Amico F, Valmasoni M, et al. intention-to-treat analysis of liver transplantation in selected, aggressively treated HCC patients exceeding the Milan criteria. Am J Transpl 2007;7:972-981 [PMID:17391137]CrossRefGoogle Scholar
  23. 23.
    Kneteman NM, Oberholzer J, Saghier MA, Meeberg GA, Blitz M, Ma MM, et al. Sirolimus-based immunosuppression for liver transplantation in the presence of extended criteria for hepatocellular carcinoma. Liver Transpl 2004;10:1201-1311 [PMID:15376305]CrossRefGoogle Scholar
  24. 24.
    Pawlik TM, Gleisner AL, Anders RA, Assumpcao L, Maley W, Choti MA. Preoperative assessment of hepatocellular carcinoma tumor grade using needle biopsy, implications for transplant eligibility. Ann Surg 2007;245:435-442 [PMID:17435551]PubMedCrossRefGoogle Scholar
  25. 25.
    Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208-1236 [PMID:16250051]PubMedCrossRefGoogle Scholar
  26. 26.
    Merani S, Majno P, Kneteman NM, Berney T, Morel P, Mentha G, et al. The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma. J Hepatol 2011;55:814-9 [PMID:21334400]PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  1. 1.Liver Transplantation CenterWest China Hospital of Sichuan UniversityChengduChina

Personalised recommendations