Zhi Qu1,2, Qi Ling3, Jill Gwiasda2, Xiao Xu4, Harald Schrem5,6, Jan Beneke2, Alexander Kaltenborn2, Christian Krauth1,2, Heiko Mix2, Jürgen Klempnauer7, Nikos Emmanouilidis7. 1. Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany. 2. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany. 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. 4. 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. zjxu@zju.edu.cn. 5. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany. schrem.harald@mh-hannover.de. 6. General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. schrem.harald@mh-hannover.de. 7. General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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.
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.
Authors: F Y Yao; L Ferrell; N M Bass; J J Watson; P Bacchetti; A Venook; N L Ascher; J P Roberts Journal: Hepatology Date: 2001-06 Impact factor: 17.425
Authors: Sung Hoon Yang; Kyung-Suk Suh; Hae Won Lee; Eung-Ho Cho; Jai Young Cho; Yong Beom Cho; In Hwan Kim; Nam-Joon Yi; Kuhn Uk Lee Journal: Surgery Date: 2007-03-23 Impact factor: 3.982
Authors: Nikos Emmanouilidis; Rickmer Peters; Bastian P Ringe; Zeynep Güner; Wolf Ramackers; Hüseyin Bektas; Frank Lehner; Michael Manns; Jürgen Klempnauer; Harald Schrem Journal: J Transplant Date: 2016-01-10