2008
DOI: 10.1111/j.1600-6143.2008.02409.x
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Liver Transplantation for Hepatocellular Carcinoma: Results of Down-Staging in Patients Initially Outside the Milan Selection Criteria

Abstract: Conventional criteria for liver transplantation for patients with hepatocellular carcinoma are single HCC ≤ 5 cm or less than or equal to three HCCs ≤ 3 cm. We prospectively evaluated the possibility of slightly extending these criteria in a down-staging protocol, which included patients initially outside conventional criteria: single HCC 5-6 cm or two HCCs ≤ 5 cm or less than six HCCs ≤ 4 cm and sum diameter ≤ 12 cm, but within Milan criteria in the active tumors after the down-staging procedures. The outcome… Show more

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Cited by 340 publications
(355 citation statements)
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“…39,63,77 In agreement with the proven role of AFP as a prognostic tool (rather than a diagnostic tool) for HCC, high serum levels of AFP have been correlated with a deterioration in the prognosis of patients with tumors belonging to the MC category, even though a precise cutoff is missing (Table 3). Although the strength of the evidence is impoverished by the suboptimal quality (average NOS score ¼ 6) and the limited number of studies, 12,18,20,24,35,36,[38][39][40]51,54,65,80 AFP in clinical practice represents a quite reliable and noninvasive tool for capturing potentially more aggressive HCCs within the MC. In some centers, values > 400 or >1000 ng/mL are often important determinants for delisting patients otherwise eligible for LT. 24,119,120 4.…”
Section: In Comparison With Patients With Hccs Exceed-mentioning
confidence: 99%
“…39,63,77 In agreement with the proven role of AFP as a prognostic tool (rather than a diagnostic tool) for HCC, high serum levels of AFP have been correlated with a deterioration in the prognosis of patients with tumors belonging to the MC category, even though a precise cutoff is missing (Table 3). Although the strength of the evidence is impoverished by the suboptimal quality (average NOS score ¼ 6) and the limited number of studies, 12,18,20,24,35,36,[38][39][40]51,54,65,80 AFP in clinical practice represents a quite reliable and noninvasive tool for capturing potentially more aggressive HCCs within the MC. In some centers, values > 400 or >1000 ng/mL are often important determinants for delisting patients otherwise eligible for LT. 24,119,120 4.…”
Section: In Comparison With Patients With Hccs Exceed-mentioning
confidence: 99%
“…[3][4][5][6][7][8][9][10][11][12] This outcome measure starts from the time at which a patient with HCC is subjected to down-staging treatments before LT listing and takes into consideration tumor progression beyond acceptable limits (ie, changes in the tumor size or number, vascular invasion, or extrahepatic tumor dissemination) that leads to delisting or dropout from the LT waiting list. Dropout from the waiting list depends not only on the tumor biology but also on the time on the wait-list for deceased donor LT in a particular transplant center or region.…”
Section: What Are the Goals And Expected Outcomes Of Down-staging?mentioning
confidence: 99%
“…Most of the published reports have used the Milan criteria as the endpoint of down-staging. [3][4][5][6][7][8] The Response Evaluation Criteria in Solid Tumors (RECIST) [9][10][11] and other criteria 12,13 have also been used to define the response to tumor down-staging, especially when eligibility for LT is not restricted to patients meeting the Milan criteria. Because we are defining the response to down-staging according to measurements of only the viable tumor after locoregional therapy, the RECIST approach does not fit well into this scheme: it defines treatment responses according to the measurement of the entire tumor (including both the ablated or necrotic portion and the viable tumor).…”
Section: What Should Be the Endpoint Or Endpoints Of Down-staging?mentioning
confidence: 99%
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