Expansion of the Milan criteria without any sacrifice: combination of the Hangzhou criteria with the pre-transplant platelet-to-lymphocyte ratio

Xia, Weiliang; Ke, Qinghong; Guo, Hua; Wang, Weilin; Zhang, Min; Shen, Yan; Wu, Jian; Xu, Xiao; Yan, Sheng; Yu, Jun; Zhang, Mangli; Zheng, Shusen

doi:10.1186/s12885-016-3028-0

Cited by 18 publications

(10 citation statements)

References 29 publications

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“…The Hangzhou criteria have been validated by many clinical studies in China, France, and Germany. All these studies confirmed that HCC patients who fulfill the Hangzhou criteria have achieved an acceptable post-LT 5-year survival of 72–76% and recurrence rate of 20–23% [7,20–24]. In accordance with these studies, our study showed that the early recurrence rate was 15.8% with an OS rate of 71.6% for patients who met the Hangzhou criteria.…”

Section: Discussionsupporting

confidence: 88%

Prediction of Early Recurrence of Hepatocellular Carcinoma in Patients with Cirrhosis Who Had Received Deceased Donor Liver Transplantation: A Multicenter Study

et al. 2019

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BackgroundEarly recurrence after liver transplantation (LT) is still a clinical problem. This multicenter study evaluated the Milan, Hangzhou, and AFP model-based criteria for prediction of early recurrence of HCC in patients with cirrhosis who had undergone LT.Material/MethodsFrom the China Liver Transplant Registry (CLTR) database, we analyzed data of 589 HCC patients who had undergone LT between Jan 2015 and Jan 2019. Imaging data and AFP levels were evaluated immediately before LT. Recurrence and overall survival rates at 2 years were tested using the Kaplan-Meier estimate. The Milan criteria, Hangzhou criteria, and AFP model-based criteria were evaluated.ResultsWe found that 62.0%, 91.2%, and 67.6% of patients were within the Milan criteria, Hangzhou criteria, and AFP model-based criteria, respectively. The 2-year recurrence rate was 8.9%, 15.8%, and 11.8% with corresponding overall survival of 85.3%, 82.7%, and 86.5%, respectively. The 2-year recurrence rate was different in patients fulfilling and exceeding the AFP model-based criteria among patients who met either the Milan criteria (7.9% vs. 18.8%, HR=3.83, p=0.006) or Hangzhou criteria (12.0% vs. 27.6%, HR=2.95, p<0.001). However, the 2-year recurrence rate was not significantly different among patients who were beyond either the Milan or Hangzhou criteria.ConclusionsFor the prediction of early recurrence of HCC in patients with cirrhosis after liver transplantation, Milan criteria, Hangzhou criteria, and AFP model-based criteria are effective predictive tools for stratification of patients into low- and high-risk groups of recurrence with different prognoses. The AFP model-based criteria can identify a subgroup of patients with high risk of recurrence among patients who met either Milan or Hangzhou criteria.

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Section: Discussionsupporting

confidence: 88%

Prediction of Early Recurrence of Hepatocellular Carcinoma in Patients with Cirrhosis Who Had Received Deceased Donor Liver Transplantation: A Multicenter Study

et al. 2019

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“…Of the remaining 11 papers, 6 were not considered eligible after full-text evaluation. Two studies coming from Hangzhou China were performed on the same population, so only one of these studies was selected for the last analysis[ 23 , 24 ].…”

Section: Resultsmentioning

confidence: 99%

Platelet-to-lymphocyte ratio in the setting of liver transplantation for hepatocellular cancer: A systematic review and meta-analysis

Lai¹,

Melandro²,

Laureiro³

et al. 2018

WJG

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AIMTo perform a systematic review and meta-analysis on platelet-to-lymphocyte ratio (PLR) as a risk factor for post-transplant hepatocellular cancer (HCC) recurrence.METHODSA systematic literature search was performed using PubMed. Participants of any age and sex, who underwent liver transplantation for HCC were considered following these criteria: (1) studies comparing pre-transplant low vs high PLR values; (2) studies reporting post-transplant recurrence rates; and (3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measure was set for HCC recurrence after transplantation.RESULTSA total of 5 articles, published between 2014 and 2017, fulfilled the selection criteria. As for the quality of the reported studies, all the investigated articles presented an overall high quality. A total of 899 cases were investigated: 718 cases (80.0%) were males. Three studies coming from European countries and one from Japan presented HCV as the main cause of cirrhosis. On the opposite, one Chinese study presented a greater incidence of HBV-related cirrhotic cases. In all the studies apart one, the PLR cut-off value of 150 was reported. At meta-analysis, high PLR value was associated with a significant increase in recurrence after transplantation (OR = 3.33; 95%CI: 1.78-6.25; P < 0.001). A moderate heterogeneity was observed among the identified studies according to the Higgins I2 statistic value.CONCLUSIONPre-transplant high PLR values are connected with an increased risk of post-operative recurrence of hepatocellular cancer. More studies are needed for better clarify the biological mechanisms of this results.

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“…However, this association must be taken in consideration with great caution since a moderate level of heterogeneity was found among the studies included. In a recent study by Xia et al[84], PLR failed to predict HCC recurrence in patients meeting Milan criteria, but the 5-year recurrence-free survival in patients with HCC beyond Milan criteria but within Hangzhou criteria (total tumor diameter of ≤ 8 cm or > 8 cm, well or moderately differentiated and pretransplant AFP of < 400 ng/mL and PLR < 120) was comparable to the figure for patients within Milan criteria (73.3% vs 72.8%).…”

Section: Systemic Inflammation Markersmentioning

confidence: 99%

Serum biomarkers and risk of hepatocellular carcinoma recurrence after liver transplantation

Cítores¹,

Lucena²,

Fuente³

et al. 2019

WJH

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Liver transplantation (LT) is the only potentially curative treatment for selected patients with cirrhosis and hepatocellular carcinoma (HCC) who are not candidates for resection. When the Milan criteria are strictly applied, 75% to 85%of 3- to 4-year actuarial survival rates are achieved, but up to 20% of the patients experience HCC recurrence after transplantation. The Milan criteria are based on the preoperative tumor macromorphology, tumor size and number on computed tomography or magnetic resonance imaging that neither correlate well with posttransplant histological study of the liver explant nor accurately predict HCC recurrence after LT, since they do not include objective measures of tumor biology. Preoperative biological markers, including alpha-fetoprotein, des-gamma-carboxiprothrombin or neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, can predict the risk for HCC recurrence after transplantation. These biomarkers have been proposed as surrogate markers of tumor differentiation and vascular invasion, with varied risk magnitudes depending on the defined cutoffs. Different studies have shown that the combination of one or several biomarkers integrated into prognostic models predict the risk of HCC recurrence after LT more accurately than Milan criteria alone. In this review, we focus on the potential utility of these serum biological markers to improve the performance of Milan criteria to identify patients at high risk of tumoral recurrence after LT.

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Expansion of the Milan criteria without any sacrifice: combination of the Hangzhou criteria with the pre-transplant platelet-to-lymphocyte ratio

Cited by 18 publications

References 29 publications

Prediction of Early Recurrence of Hepatocellular Carcinoma in Patients with Cirrhosis Who Had Received Deceased Donor Liver Transplantation: A Multicenter Study

Prediction of Early Recurrence of Hepatocellular Carcinoma in Patients with Cirrhosis Who Had Received Deceased Donor Liver Transplantation: A Multicenter Study

Platelet-to-lymphocyte ratio in the setting of liver transplantation for hepatocellular cancer: A systematic review and meta-analysis

Serum biomarkers and risk of hepatocellular carcinoma recurrence after liver transplantation

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