Liver transplantation for hepatocellular carcinoma: Further considerations on selection criteria

Authors

  • Matteo Ravaioli,

    1. Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Giorgio Ercolani,

    1. Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Matteo Cescon,

    1. Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Gaetano Vetrone,

    1. Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Claudio Voci,

    1. Department of Statistical Sciences, Pathology Division of the “F. Addarii” Institute, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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    • Statistical analysis was performed by C.V.

  • Walter Franco Grigioni,

    1. Department of Onco-hematology, Pathology Division of the “F. Addarii” Institute, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Antonia D'Errico,

    1. Department of Onco-hematology, Pathology Division of the “F. Addarii” Institute, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Giorgio Ballardini,

    1. Department of Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Antonino Cavallari,

    1. Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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  • Gian Luca Grazi

    Corresponding author
    1. Department of Surgery and Transplantation, Surgical Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
    • Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
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    • Telephone: 39.051.63.64.750; Fax: 39.051.30.49.02


Abstract

The selection criteria in liver transplantation for HCC are a matter of debate. We reviewed our series, comparing two periods: before and after 1996, when we started to apply the Milan criteria. The study population was composed of patients with a preoperative diagnosis of HCC, confirmed by the pathological report and with a survival of >1 year. Preoperative staging as revealed by radiological imagining was distinguished from postoperative data, including the variable of tumor volume. After 1996 tumor recurrences significantly decreased (6 out of 15 cases, 40% vs. 3 out of 48, 6.3%, P < .005) and 5-year patient survival improved (42% vs. 83%, P < .005). Not meeting the Milan criteria was significantly related to higher recurrence rate (37.5% vs. 12.7%, P < .05) and to lower 5-year patient survival (38% vs. 78%, P < .005%) in the preoperative analysis, but not in the postoperative one. The alfa-fetoprotein level of more than 30 ng/dL and the preoperative tumor volume of more than 28 cm3 predicted HCC recurrences in the univariate and mutivariate analysis (P < .005 and P < .05, respectively). The ROC curve showed a linear correlation between preoperative tumor volume and HCC recurrence. Milan criteria significantly reduced tumor recurrences after liver transplantation, improving long-term survival. In conclusion, the efficacy of tumor selection criteria must be analyzed with the use of preoperative data, to avoid bias of the postoperative evaluation. Tumor volume and alfa-fetoprotein level may improve the selection of patients. (Liver Transpl 2004;10:1195–1202.)

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