2021
DOI: 10.21037/tgh.2020.01.06
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Comparison between Milan and UCSF criteria for liver transplantation in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Abstract: Background: Liver transplantation is the main treatment for hepatocellular carcinoma (HCC). However, because of the limited supply of transplant organs, it is necessary to adopt a criterion that selects patients who will achieve adequate survival after transplantation. The aim of this review is to compare the two main staging criteria of HCC for the indication of liver transplantation (Milan and UCSF) and to analyze the posttransplantation survival rate at 1, 3 and 5 years.Methods: This is a systematic review … Show more

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Cited by 29 publications
(20 citation statements)
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“…In order to limit LT to those with poor post-LT outcomes, HCC waitlist priority has mainly relied on two criteria: Milan criteria (solitary tumor <5 cm or up to three nodules and each <3 cm in size, without major vascular invasion) and University of California-San Francisco (UCSF, solitary tumor of 6.5 cm, or three nodules with the largest diameter of 4.5 cm and a total tumor diameter of 8 cm) criteria, to exclude those with high risks of tumor recurrence ( 54 , 55 ). Studies indicated that HCC patients within the Milan and UCSF criteria had equivalent survival rates and recurrence rates, and surgical outcomes were comparable for MVI-negative patients within or beyond Milan criteria (3.3% versus 4.7%) ( 13 , 56 ). Accordingly, based on these surveys, LT for HCCs beyond the Milan criteria was an acceptable and life-saving method.…”
Section: And Surgical Outcomesmentioning
confidence: 99%
“…In order to limit LT to those with poor post-LT outcomes, HCC waitlist priority has mainly relied on two criteria: Milan criteria (solitary tumor <5 cm or up to three nodules and each <3 cm in size, without major vascular invasion) and University of California-San Francisco (UCSF, solitary tumor of 6.5 cm, or three nodules with the largest diameter of 4.5 cm and a total tumor diameter of 8 cm) criteria, to exclude those with high risks of tumor recurrence ( 54 , 55 ). Studies indicated that HCC patients within the Milan and UCSF criteria had equivalent survival rates and recurrence rates, and surgical outcomes were comparable for MVI-negative patients within or beyond Milan criteria (3.3% versus 4.7%) ( 13 , 56 ). Accordingly, based on these surveys, LT for HCCs beyond the Milan criteria was an acceptable and life-saving method.…”
Section: And Surgical Outcomesmentioning
confidence: 99%
“…The criteria include patients with a single HCC lesion up to 5 cm in diameter or with 2 to 3 HCC lesions up to 3 cm in diameter without macrovascular invasion or extrahepatic tumor growth. Five-year OS after transplantation for patients within the Milan criteria is reported to be around 70% with 10% to 15% recurrence rates[ 5 , 27 ]. Although initially defined in a series of only 48 patients, the Milan criteria are nowadays widely accepted and have been adopted by many guidelines including those of the European Association for the Study of the Liver-European Organization for Research and Treatment of Cancer (EASL-EROTC), the American Association for the Study of Liver Diseases (AASLD), as well as by Asian guidelines.…”
Section: Primary Liver Cancermentioning
confidence: 99%
“…Strict adherence to morphometric selection models, like the Milan or University of California San Francisco criteria, did not prove effective for persistently reducing the oncologic risk below 20% while, in turn, many patients with lowaggressive tumors exceeding standard tumor burden limits had been excluded from potentially curative LT option. [3][4][5] It emerged clearly from numerous studies that biological behavior rather than tumor load determines the oncologic risk and post-LT outcome. 5,6 In addition to intrinsic features of unfavorable tumor phenotype, like angioinvasiveness and poor differentiation, host systemic inflammatory response reaction is meanwhile accepted as another important trigger of tumor progression and metastasis.…”
Section: Introductionmentioning
confidence: 99%
“…Clearly, the sole use of tumor size and number has in the past proven inappropriate for selecting eligible liver transplant recipients. [1][2][3][4][5] Nowadays, vascular invasion instead of morphologic tumor burden is considered as most adverse prognostic factor. 34 There is convincing evidence that LT of non-angioinvasive HCC patients is associated with low recurrence risk, regardless of meeting or exceeding the MC.…”
mentioning
confidence: 99%