TY - JOUR
T1 - Combination of biological and morphological parameters for the selection of patients with hepatocellular carcinoma waiting for liver transplantation.
AU - Lai, Quirino
AU - Avolio, Alfonso Wolfango
AU - Manzia, Tommaso M.
AU - Sorge, Roberto
AU - Agnes, Salvatore
AU - Tisone, Giuseppe
AU - Berloco, Pasquale B.
AU - Rossi, Massimo
PY - 2012
Y1 - 2012
N2 - Abstract: Background: In the last several years, there has been no agreement on how to possibly expand the Milan criteria (MC) in the selection of patients with hepatocellular carcinoma (HCC) for listing for liver transplant (LT). The aim of the study is to evaluate morphological and biological tumor parameters to identify new expanded criteria for the selection of patients with HCC as candidates for LT.
Methods: We retrospectively analyzed 158 consecutive patients with HCC who underwent LT.
Results: Twelve (7.6%) recurrences were observed. At multivariate analysis, alpha-fetoprotein (AFP) >400 ng/mL (odds ratio [OR] 8.4, p < 0.01) and total tumor diameter (TTD) >8 cm (OR 7.4, p = 0.01) were the strongest predictors for recurrence. AFP-TTD criteria resulted in a low five-yr recurrence rate (4.9%) and an increased number of LT compared with the MC (22.2% increase). The five-yr disease-free survival rate was 74.4% in AFP-TTD criteria in patients, with a higher effectiveness in stratifying the cohort with respect to the MC.
Conclusions: Both AFP and TTD are good independent predictors of HCC recurrence. Their combination appears to obtain a better selection of can- didates for LT without worsening patient survival and recurrence rates. This approach allows for an increase in the number of potentially transplantable patients.
AB - Abstract: Background: In the last several years, there has been no agreement on how to possibly expand the Milan criteria (MC) in the selection of patients with hepatocellular carcinoma (HCC) for listing for liver transplant (LT). The aim of the study is to evaluate morphological and biological tumor parameters to identify new expanded criteria for the selection of patients with HCC as candidates for LT.
Methods: We retrospectively analyzed 158 consecutive patients with HCC who underwent LT.
Results: Twelve (7.6%) recurrences were observed. At multivariate analysis, alpha-fetoprotein (AFP) >400 ng/mL (odds ratio [OR] 8.4, p < 0.01) and total tumor diameter (TTD) >8 cm (OR 7.4, p = 0.01) were the strongest predictors for recurrence. AFP-TTD criteria resulted in a low five-yr recurrence rate (4.9%) and an increased number of LT compared with the MC (22.2% increase). The five-yr disease-free survival rate was 74.4% in AFP-TTD criteria in patients, with a higher effectiveness in stratifying the cohort with respect to the MC.
Conclusions: Both AFP and TTD are good independent predictors of HCC recurrence. Their combination appears to obtain a better selection of can- didates for LT without worsening patient survival and recurrence rates. This approach allows for an increase in the number of potentially transplantable patients.
KW - ALPHA FETOPROTEIN
KW - HEPATOCELLULAR CARCINOMA
KW - LIVER TRANSPLANTATION
KW - MILAN CRITERIA
KW - WAITING LIST
KW - ALPHA FETOPROTEIN
KW - HEPATOCELLULAR CARCINOMA
KW - LIVER TRANSPLANTATION
KW - MILAN CRITERIA
KW - WAITING LIST
UR - http://hdl.handle.net/10807/36865
UR - http://eu.wiley.com/wileycda/wileytitle/productcd-ctr.html
U2 - 10.1111/j.1399-0012.2011.01572.x
DO - 10.1111/j.1399-0012.2011.01572.x
M3 - Article
SN - 0902-0063
VL - 26
SP - 125
EP - 131
JO - Clinical Transplantation
JF - Clinical Transplantation
ER -