BACKGROUND: In patients with hepatocellular carcinoma (HCC), the outcome after liver transplantation (LT) is excellent if tumor characteristics are within the Milan criteria (MC). Expanded Asan criteria (AC) have not yet been validated in Western countries. METHODS: A total of 76 patients with HCC underwent LT. Patients were divided and compared according to Milan, UCSF, and Asan criteria. Differences between pre- and post-operative assessment were evaluated. Overall survival (OS) and disease-free survival (DFS) were compared between groups. Predictors of recurrence were investigated. RESULTS: Asan criteria provided 26% and 15% more criteria-fitting patients than MC and UCSF pre-operatively while 49% and 35% at pathological evaluation. Discrepancy between pre- and post-operative evaluation was 32% for MC, 33% for UCSF, and 18% for AC (p = 0.06). After a median follow-up of 70.5 months, patients exceeding MC but fulfilling Asan had comparable 5-yr OS and DFS to patients fulfilling MC (p = 0.17; p = 0.29). Patients exceeding UCSF but fulfilling AC had comparable 5-yr OS and DFS to patients fulfilling UCSF (p = 0.26; p = 0.32). Number of nodules, macro-vascular invasion, capsular invasion, and exceeding AC predicted recurrence at multivariate analysis (p = 0.01, 0.03, 0.01, 0.02, respectively). CONCLUSIONS: The extension to AC allows increasing the number of patients eligible for LT without affecting OS and DFS.
BACKGROUND: In patients with hepatocellular carcinoma (HCC), the outcome after liver transplantation (LT) is excellent if tumor characteristics are within the Milan criteria (MC). Expanded Asan criteria (AC) have not yet been validated in Western countries. METHODS: A total of 76 patients with HCC underwent LT. Patients were divided and compared according to Milan, UCSF, and Asan criteria. Differences between pre- and post-operative assessment were evaluated. Overall survival (OS) and disease-free survival (DFS) were compared between groups. Predictors of recurrence were investigated. RESULTS:Asan criteria provided 26% and 15% more criteria-fitting patients than MC and UCSF pre-operatively while 49% and 35% at pathological evaluation. Discrepancy between pre- and post-operative evaluation was 32% for MC, 33% for UCSF, and 18% for AC (p = 0.06). After a median follow-up of 70.5 months, patients exceeding MC but fulfilling Asan had comparable 5-yr OS and DFS to patients fulfilling MC (p = 0.17; p = 0.29). Patients exceeding UCSF but fulfilling AC had comparable 5-yr OS and DFS to patients fulfilling UCSF (p = 0.26; p = 0.32). Number of nodules, macro-vascular invasion, capsular invasion, and exceeding AC predicted recurrence at multivariate analysis (p = 0.01, 0.03, 0.01, 0.02, respectively). CONCLUSIONS: The extension to AC allows increasing the number of patients eligible for LT without affecting OS and DFS.
Authors: Savio G Barreto; Simone I Strasser; Geoffrey W McCaughan; Michael A Fink; Robert Jones; John McCall; Stephen Munn; Graeme A Macdonald; Peter Hodgkinson; Gary P Jeffrey; Bryon Jaques; Michael Crawford; Mark E Brooke-Smith; John W Chen Journal: Cancers (Basel) Date: 2022-06-03 Impact factor: 6.575
Authors: Robert Mahn; Farsaneh Sadeghlar; Alexandra Bartels; Taotao Zhou; Tobias Weismüller; Patrick Kupczyk; Carsten Meyer; Florian C Gaertner; Marieta Toma; Tim Vilz; Petra Knipper; Tim Glowka; Steffen Manekeller; Jörg Kalff; Christian P Strassburg; Maria A Gonzalez-Carmona Journal: Medicine (Baltimore) Date: 2021-09-24 Impact factor: 1.817
Authors: Jorge Henrique Bento de Sousa; Igor Lepski Calil; Francisco Tustumi; Douglas da Cunha Khalil; Guilherme Eduardo Gonçalves Felga; Rafael Antonio de Arruda Pecora; Marcio Dias de Almeida Journal: Transl Gastroenterol Hepatol Date: 2021-01-05
Authors: Michał Grąt; Karolina M Wronka; Jan Stypułkowski; Emil Bik; Maciej Krasnodębski; Łukasz Masior; Zbigniew Lewandowski; Karolina Grąt; Waldemar Patkowski; Marek Krawczyk Journal: Ann Surg Oncol Date: 2016-08-16 Impact factor: 5.344
Authors: Gustavo Pilotto D Sá; Fernando P P Vicentine; Alcides A Salzedas-Netto; Carla Adriana Loureiro de Matos; Luiz R Romero; Dario F P Tejada; Paulo Celso Bosco Massarollo; Gaspar J Lopes-Filho; Adriano M Gonzalez Journal: Arq Bras Cir Dig Date: 2016 Nov-Dec