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Hangzhou criteria are more accurate than Milan criteria in predicting long-term survival after liver transplantation for HCC in Germany

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Abstract

Background

Milan criteria are used for patient selection in liver transplantation for hepatocellular carcinoma (HCC). Hangzhou criteria have been shown in China to enable access to liver transplantation for more patients when compared to Milan criteria without negative effects on long-term survival. The purpose of this study was to evaluate the Hangzhou criteria in a German cohort.

Methods

One hundred fifty-nine patients transplanted for HCC between 1975 and 2010 were investigated. Patients were categorized into four groups depending on the fulfillment of Milan and Hangzhou criteria. General and tumor baseline characteristics were compared. Overall and tumor-free survival rates were investigated with the Kaplan-Meier analysis.

Results

One-, 3-, 5-, and 10-year survival rates for patients fulfilling Milan criteria (n = 68) were 89.7, 83.7, 75.8, and 62.1%, respectively, versus 89.8, 82.2, 75.2, and 62.6% for patients fulfilling Hangzhou criteria (n = 109) (p = 0.833). When comparing patients exceeding Milan or Hangzhou criteria, survival rates were 75.3, 53.2, 48.1, and 41.1% versus 63.3, 31.4, 26.9, and 22.1%, respectively (p = 0.019). The comparison of tumor-free survival rates in patients fulfilling Milan or Hangzhou criteria was statistically not significant (p = 0.785), whereas the comparison of the groups exceeding the criteria showed significantly worse survival for patients outside Hangzhou criteria (p = 0.007). The proportion of patients fulfilling Hangzhou criteria (68.6%) was significantly larger as compared to the proportion fulfilling Milan criteria (42.8%) (p < 0.001).

Conclusion

Hangzhou criteria are more accurate in predicting long-term survival after liver transplantation for HCC in Germany. Deployment of the Hangzhou criteria for patient selection could enlarge the pool of transplantable patients.

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Funding

This work was supported by a grant from the German Federal Ministry of Education and Research (reference number: 01EO1302).

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Author notes

  1. Zhi Qu and Qi Ling contributed equally to this work.

Authors and Affiliations

  1. Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany

    Zhi Qu & Christian Krauth

  2. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany

    Zhi Qu, Jill Gwiasda, Harald Schrem, Jan Beneke, Alexander Kaltenborn, Christian Krauth & Heiko Mix

  3. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79, Qingchun Road, Hangzhou, 310003, Zhejiang Province, China

    Qi Ling & Xiao Xu

  4. General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Harald Schrem, Jürgen Klempnauer & Nikos Emmanouilidis

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  1. Zhi Qu
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Contributions

Zhi Qu: final refinement of study design, performed data collection and data analysis, and writing of the manuscript; Qi Ling: clinical expert input, final refinement of study design, and writing of the manuscript; Jill Gwiasda: contributed to the study design, to data collection and data analysis, critical appraisal, and revision of the manuscript draft; Xiao Xu: clinical expert input, contributed to the study design, critical appraisal, and revision of the manuscript draft; Harald Schrem: clinical expert input, contributed to the study design, critical appraisal, and revision of the manuscript draft; Jan Beneke: contributed to the study design, critical appraisal, and revision of the manuscript draft; Alexander Kaltenborn: contributed to the study design, critical appraisal, and revision of the manuscript draft; Christian Krauth: contributed to the study design, critical appraisal, and revision of the manuscript draft; Heiko Mix: clinical expert input, contributed to the study design, critical appraisal, and revision of the manuscript draft; Jürgen Klempnauer: clinical expert input, contributed to the study design, critical appraisal, and revision of the manuscript draft; Nikos Emmanouilidis: clinical expert input, contributed to data collection and data analysis, critical appraisal, and revision of the manuscript draft

Corresponding authors

Correspondence to Xiao Xu or Harald Schrem.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee of Hannover Medical School approved of this retrospective study (approval decision number 1683-2013).

Informed consent

Informed consent was obtained from all individual participants included in the study. Patients provided informed consent that their data may be used for scientific purposes at the time of hospital admission which is the general policy of our institution.

Additional information

Zhi Qu and Qi Ling share the first authorship.

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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 403, 643–654 (2018). https://doi.org/10.1007/s00423-018-1696-8

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  • DOI: https://doi.org/10.1007/s00423-018-1696-8

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