Alpha-foetoprotein; Asan criteria; Extended transplant criteria; Hepatocellular carcinoma; Metroticket 2.0 model; Up-to-7 criteria; organ transplantation; cancer; Burny
Abstract :
[en] BACKGROUND: Recent studies indicate that a group of patients with cirrhosis receiving a liver transplantation for hepatocellular cancer (HCC) beyond the Milan Criteria (MC) can achieve a similar outcome compared to patients within these criteria. This study aims to investigate the value of the Asan critera (AC), up-to-7 criteria (UT7), French alpha-foetoprotein (AFP) model and Metroticket 2.0 (MT2.0) model compared to the MC. METHODS: 526 patients transplanted for non-metastatic HCC were analyzed. Patient groups within and beyond MC and extended criteria were determined according to radiological assessment and AFP value at listing. RESULTS: Overall survival (OS) and recurrence (RR) rates were similar between patients within MC and all extended criteria. Five-year OS within MC was 71.3% compared to 70.9% for AC, 71.4% for UT7, 69.7% for AFP-model and 71.0% for MT2.0 criteria. Five-year RR within MC was 12.3% compared to 13.5% for AC, 13.0% for UT7, 14.3% for AFP-model and 13.2% for MT2.0 criteria. Patients beyond MC but within the extended criteria had tendency towards higher recurrence. CONCLUSIONS: All validated extended criteria (AC, UT7, AFP-model and MT2.0) could be proposed as alternatives to the MC with similar outcome. Prospective data are awaited to assess recurrence beyond MC.
Disciplines :
Gastroenterology & hepatology Surgery
Author, co-author :
Degroote, H
Callebout, E
Samuele, I
Dekervel, J
Schreiber, J
Pirenne, J
Verslype, C
ysebaert, D
Michielsen, P
Lucidi, V
Moreno, C
DETRY, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Chirurgie abdo, sénologique, endocrine et de transplantation
Delwaide, Jean ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Mazzaferro, V., Regalia, E., Doci, R., Andreola, S., Pulvirenti, A., Bozzetti, F., et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N. Engl. J. Med. 334:11 (1996), 693–699.
Mazzaferro, V., Bhoori, S., Sposito, C., Bongini, M., Langer, M., Miceli, R., et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transplant. 17:Suppl 2 (2011), S44–57.
Germani, G., Gurusamy, K., Garcovich, M., Toso, C., Fede, G., Hemming, A., et al. Which matters most: number of tumors, size of the largest tumor, or total tumor volume?. Liver Transplant. 17:Suppl 2 (2011), S58–66.
Yao, F.Y., Xiao, L., Bass, N.M., Kerlan, R., Ascher, N.L., Roberts, J.P., Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am. J. Transplant. 7:11 (2007), 2587–2596.
Qu, Z., Ling, Q., Gwiasda, J., Xu, X., Schrem, H., Beneke, J., et al. Hangzhou criteria are more accurate than Milan criteria in predicting long-term survival after liver transplantation for HCC in Germany. Langenbeck's Arch. Surg. 403:5 (2018), 643–654.
Lee, S.G., Hwang, S., Moon, D.B., Ahn, C.S., Kim, K.H., Sung, K.B., et al. Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transplant. 14:7 (2008), 935–945.
Balci, D., Dayangac, M., Yaprak, O., Akin, B., Duran, C., Killi, R., et al. Living donor liver transplantation for hepatocellular carcinoma: a single center analysis of outcomes and impact of different selection criteria. Transpl. Int. 24:11 (2011), 1075–1083.
Bonadio, I., Colle, I., Geerts, A., Smeets, P., Berardi, G., Praet, M., et al. Liver transplantation for hepatocellular carcinoma comparing the Milan, UCSF, and Asan criteria: long-term follow-up of a Western single institutional experience. Clin. Transplant. 29:5 (2015), 425–433.
Mazzaferro, V., Llovet, J.M., Miceli, R., Bhoori, S., Schiavo, M., Mariani, L., et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 10:1 (2009), 35–43.
Mazzaferro, V., Sposito, C., Zhou, J., Pinna, A.D., De Carlis, L., Fan, J., et al. Metroticket 2.0 model for analysis of competing risks of death following liver transplantation for hepatocellular carcinoma. Gastroenterology, 2017.
Duvoux, C., Roudot-Thoraval, F., Decaens, T., Pessione, F., Badran, H., Piardi, T., et al. Liver transplantation for hepatocellular carcinoma: a model including alpha-fetoprotein improves the performance of Milan criteria. Gastroenterology 143:4 (2012), 986–994 e3; quiz e14-5.
Vibert, E., Azoulay, D., Hoti, E., Iacopinelli, S., Samuel, D., Salloum, C., et al. Progression of alphafetoprotein before liver transplantation for hepatocellular carcinoma in cirrhotic patients: a critical factor. Am. J. Transplant. 10:1 (2010), 129–137.
Toso, C., Asthana, S., Bigam, D.L., Shapiro, A.M., Kneteman, N.M., Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology 49:3 (2009), 832–838.
Lai, Q., Nicolini, D., Inostroza Nunez, M., Iesari, S., Goffette, P., Agostini, A., et al. A novel prognostic index in patients with hepatocellular cancer waiting for liver transplantation: time-radiological-response-alpha-fetoprotein-inflammation (TRAIN) score. Ann. Surg., 2016.
Lai, Q., Vitale, A., Iesari, S., Finkenstedt, A., Mennini, G., Spoletini, G., et al. Intention-to-treat survival benefit of liver transplantation in patients with hepatocellular cancer. Hepatology 66:6 (2017), 1910–1919.
Halazun, K.J., Tabrizian, P., Najjar, M., Florman, S., Schwartz, M., Michelassi, F., et al. Is it time to abandon the milan criteria?: results of a bicoastal US collaboration to redefine hepatocellular carcinoma liver transplantation selection policies. Ann. Surg. 268:4 (2018), 690–699.
Ciccarelli, O., Lai, Q., Goffette, P., Finet, P., De Reyck, C., Roggen, F., et al. Liver transplantation for hepatocellular cancer: UCL experience in 137 adult cirrhotic patients. Alpha-foetoprotein level and locoregional treatment as refined selection criteria. Transpl. Int. 25:8 (2012), 867–875.
Clavien, P.A., Lesurtel, M., Bossuyt, P.M., Gores, G.J., Langer, B., Perrier, A., et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 13:1 (2012), e11–22.
European Association for the Study of the Liver, Electronic address eee, European association for the study of the L. EASL clinical practice guidelines: management of hepatocellular carcinoma. J. Hepatol. 69:1 (2018), 182–236.
Yao, F.Y., Liver transplantation for hepatocellular carcinoma: beyond the Milan criteria. Am. J. Transplant. 8:10 (2008), 1982–1989.
Volk, M.L., Vijan, S., Marrero, J.A., A novel model measuring the harm of transplanting hepatocellular carcinoma exceeding Milan criteria. Am. J. Transplant.: Off. J. Am. Soc. Transplant. Am. Soc. Transplant Surg. 8:4 (2008), 839–846.
Detry, O., Govaerts, L., Deroover, A., Vandermeulen, M., Meurisse, N., Malenga, S., et al. Prognostic value of (18)F-FDG PET/CT in liver transplantation for hepatocarcinoma. World J. Gastroenterol. 21:10 (2015), 3049–3054.
Melloul, E., Lesurtel, M., Carr, B.I., Clavien, P.A., Developments in liver transplantation for hepatocellular carcinoma. Semin. Oncol. 39:4 (2012), 510–521.
Geissler, E.K., Schnitzbauer, A.A., Zulke, C., Lamby, P.E., Proneth, A., Duvoux, C., et al. Sirolimus use in liver transplant recipients with hepatocellular carcinoma: a randomized, multicenter, open-label phase 3 trial. Transplantation 100:1 (2016), 116–125.
Lerut, J., Iesari, S., Foguenne, M., Lai, Q., Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression?. Transl. Gastroenterol. Hepatol., 2, 2017, 80.
Lai, Q., Vitale, A., Rossi, M., Cillo, U., Lerut, J., European hepatocellular cancer liver transplantation study G. Which is the true role of bridging therapies for HCC patients waiting for liver transplantation?. Ann. Surg., 2017.
Mehta, N., Guy, J., Frenette, C.T., Dodge, J.L., Osorio, R.W., Minteer, W.B., et al. Excellent outcomes of liver transplantation following down-staging of hepatocellular carcinoma to within milan criteria: a multicenter study. Clin. Gastroenterol. Hepatol.: Off Clin. Prac. J. Am. Gastroenterol. Assoc. 16:6 (2018), 955–964.
Chapman, W.C., Garcia-Aroz, S., Vachharajani, N., Fowler, K., Saad, N., Lin, Y., et al. Liver transplantation for advanced hepatocellular carcinoma after downstaging without up-front stage restrictions. J. Am. Coll. Surg., 2017.
Sapisochin, G., Goldaracena, N., Laurence, J.M., Dib, M., Barbas, A., Ghanekar, A., et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: a prospective validation study. Hepatology 64:6 (2016), 2077–2088.
