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Liver Transplantation for Hepatocellular Carcinoma: Malatya Experience and Proposals for Expanded Criteria

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An Author Correction to this article was published on 08 July 2020

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Abstract

Survival was examined from a Turkish liver transplant center of patients with HCC, to identify prognostic factors. Data from 215 patients who underwent predominantly live donor liver transplant for HCC at our institute over 12 years were included in the study and prospectively recorded. They were 152 patients within and 63 patients beyond Milan criteria. Patients beyond Milan criteria were divided into two groups according to presence or absence of tumor recurrence. Recurrence-associated factors were analyzed. These factors were then applied to the total cohort for survival analysis. We identified four factors, using multivariate analysis, that were significantly associated with tumor recurrence. These were maximum tumor diameter, degree of tumor differentiation, and serum AFP and GGT levels. A model that included all four of these factors was constructed, the ‘Malatya criteria.’ Using these Malatya criteria, we estimated DFS and cumulative survival, for patients within and beyond these criteria, and found statistically significant differences with improved survival in patients within Malatya criteria of 1, 5, and 10-year overall survival rates of 90.1%, 79.7%, and 72.8% respectively, which compared favorably with other extra-Milan extended criteria. Survival of our patients within the newly defined Malatya criteria compared favorably with other extra-Milan extended criteria and highlight the usefulness of serum AFP and GGT levels in decision-making.

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Data Availability

The raw data used to support the findings of this study are available from the corresponding author upon request.

Change history

  • 08 July 2020

    The original version of this article unfortunately contained a mistake in the author group section.

Abbreviations

AFP:

Alpha fetoprotein

ALKP:

Alkaline phosphatase

BCLC:

Barcelona Clinic Liver Cancer extended criteria

BMI:

Body mass index

CHILD:

Child-Pugh score

DFS:

Disease-free survival

ETC:

Extended Toronto criteria

GGT:

Gamma glutamyl transferase

GRWR:

Graft to recipient weight ratio

HC:

Hagzhou criteria

HCC:

Hepatocellular cancer

LT:

Liver transplantation

LDLT:

Live donor liver transplantation

MC:

Milan criteria

MELD:

Model for End Stage Liver Disease score

MRI:

Magnetic resonance imaging

MSCT:

Multislice computed tomography

MTD:

Maximal tumor diameter

NLR:

Neutrophil-lymphocyte ratio

OS:

Overall survival

OR:

Odds ratio

PET/CT:

Positron emission tomography/computerized tomography scan

PLR:

Platelet-to-lymphocyte ratio

ROC:

Receiver operating characteristics

TTS:

Total tumor size

UCSF:

University of California, San Francisco criteria

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Acknowledgments

The authors declare that there is no funding used for the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey

    Volkan Ince, Sami Akbulut, Emrah Otan, Veysel Ersan, Serdar Karakas, Tolga Tevfik Sahin, Brian I Carr, Adil Baskiran, Cemalettin Koc, Sertac Usta, Fatih Ozdemir, Bora Barut, Fatih Gonultas, Baris Sarici, Koray Kutluturk, Murat Sait Dogan, Dincer Ozgor, Abuzer Dirican, Cemalettin Aydin, Burak Isik, Cengiz Ara, Cuneyt Kayaalp, Sukru Emre & Sezai Yilmaz

  2. Department of Pathology, Medical School, Inonu University, Malatya, Turkey

    Emine Samdanci

  3. Department of Bioistatistics, Medical School, Inonu University, Malatya, Turkey

    Harika Gozukara Bag

  4. Department of Medical Oncology, Medical School, Inonu University, Malatya, Turkey

    Mustafa Dikilitas

  5. Department of Gastroenterology, Medical School, Inonu University, Malatya, Turkey

    Murat Harputluoglu & Murat Aladag

  6. Department of Radiology, Medical School, Inonu University, Malatya, Turkey

    Ramazan Kutlu

  7. Department of Pediatric Gastroenterolgy, Medical School, Inonu University, Malatya, Turkey

    Ilknur Varol

Authors
  1. Volkan Ince
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  2. Sami Akbulut
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  3. Emrah Otan
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  7. Brian I Carr
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  15. Fatih Gonultas
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  16. Baris Sarici
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  19. Dincer Ozgor
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  21. Murat Harputluoglu
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  24. Ilknur Varol
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  25. Abuzer Dirican
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  26. Cemalettin Aydin
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  27. Burak Isik
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  28. Cengiz Ara
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  29. Cuneyt Kayaalp
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  30. Sukru Emre
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  31. Sezai Yilmaz
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Correspondence to Volkan Ince.

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The original version of this article was revised: The original version of this article unfortunately contained a mistake in the author group section. The correct name of the second author is “Sami Akbulut”.

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Ince, V., Akbulut, S., Otan, E. et al. Liver Transplantation for Hepatocellular Carcinoma: Malatya Experience and Proposals for Expanded Criteria. J Gastrointest Canc 51, 998–1005 (2020). https://doi.org/10.1007/s12029-020-00424-w

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