Liver transplantation for hepatocellular carcinoma: Comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria

Abstract

We previously proposed modified staging criteria for predicting acceptable outcome after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). These were solitary tumor <6.5 cm, or three or fewer nodules with the largest lesion <4.5 cm and total tumor diameter <8 cm, without gross vascular invasion (University of California, San Francisco [UCSF] criteria). In this study, we further evaluated the performance of the Milan criteria (solitary tumor <5 cm, or three or fewer lesions none >3 cm), the UCSF criteria, and the Pittsburgh modified tumor-node-metastasis (TNM) criteria. Pathologic HCC staging according to each set of criteria was performed in 70 patients. The difference in survival when comparing 24 patients with HCC exceeding Milan criteria versus 46 patients meeting Milan criteria did not reach statistical significance (HR, 2.0; P ‫؍‬ .12). Using our definition for acceptable 2-year survival to be >70%, the 14 patients (20%) meeting UCSF criteria but exceeding Milan criteria had a 2-year survival of 86% (95% CI, 54% to 96%). Survival for Pittsburgh stage I, II, and IIIA patients as a group was significantly better than for stages IIIB and IVA patients combined (HR, 4.2; P ‫؍‬ .007), and similar to survival for patients meeting UCSF criteria. Advanced tumor exceeding UCSF criteria served reasonably well as a surrogate marker for poorly differentiated grade and microvascular invasion. In conclusion, our analyses suggest that UCSF criteria better predict acceptable posttransplant outcome than Milan criteria. UCSF criteria confer a different advantage over Pittsburgh criteria, which require information on microvascular invasion that is difficult to ascertain preoperatively without the attendant risk of biopsy. (Liver Transpl 2002;8:765-774.)

Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria

“…Our study results were consistent with previous studies that showed no survival differences in patients with HCC for both those that met and those exceeded the Milan criteria [9,16,18] and for those that met both the Milan and UCSF criteria [17,19]. Although the UCSF criteria have been shown to be associated with a longterm survival similar to the Milan criteria [23][24][25], little is known with regard to the outcomes of patients with HCC that exceed the UCSF criteria. In one of the largest series, Duff et al reported a 3-year survival of 83 % for those that met the UCSF criteria and 48 % for those exceeded the UCSF criteria [20].…”

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

“…For patients not meeting the MC, the rates of mVI and grade 3 and 4 tumors significantly increase (35%-56% and 38%-50%, respectively). 26,48 Similar rates of histological markers of tumor aggressiveness and poor prognoses have been detected in patients slightly exceeding the MC, such as patients meeting the University of California San Francisco criteria, 52,84 even though a significant proportion of patients meeting the University of California San Francisco criteria are meeting the MC as well. 24,34,47,51 We identified 10 studies 16,18,26,28,47,48,51,52,63,72 reporting frequency data for mVI and tumor grades in patients meeting or not meeting the MC, and a meta-analysis of the odds ratios was performed accordingly (Fig.…”

“…The meta-analysis included 19 studies 2,15,16,19,26,33,35,39,40,42,46,48,[53][54][55]57,63,67,84 that used different methodologies to compare the overall survival of patients meeting the MC and patients exceeding the criteria at the time of the explant pathology examination; 3949 patients were also stratified by the graft origin (deceased or living donors).…”

Role of Liver Transplantation for Hepatocellular Carcinoma

“…Yao et al compared the then proposed UCSF criteria with the Milan criteria and the Pittsburgh criteria in 70 patients transplanted for HCC. 17 The difference in survival between 24 patients beyond Milan criteria and 46 patients within Milan criteria was not significant. Fourteen patients (20%) exceeded the Milan criteria but met the UCSF criteria Poon et al from the University of Hong Kong reported that hepatitis C and microscopic venous invasion, in addition to tumor size and multifocality were independent predictors of recurrence in 247 cirrhotic patients undergoing resection or transplantation.…”