Aim: Liver transplantation (LT) for hepatocellular carcinoma (HCC)beyond the Milan criteria is still controversial. We investigated whether a policy of selective tumor down staging (DS) and patient prioritization based on clinical predictors might help improve the results of LT for non-Milan patients. Materials and methods: In January 1997 we set up a prospective trial on LT ± tumor down staging for consenting, adult patients affected with nodular-type HCC. Patients were down staged with either TACE, PEI, and/or RFA in the presence of: centrally-sited nodule(s), alpha-feto-protein serum levels ≥ 200 ng/ml, tumor grading ≥ G3, wait list times ≥ 3 months, and ineffective down staging while on wait list. Within the same UNOS status category patients were prioritized as follows: HCC > non-HCC; outside Milan > within Milan; centrally-sited > peripheral nodule(s), serum AFP levels, time on wait list, and ineffective > effective DS. Objective measures were: total patients enrolled; drop out rate; transplant rate; post-transplant recurrence rate, overall and disease-free survival rates. Data were analyzed within one year of last enrolment on an intent-to-treat basis. Results: Until October 2004 a total of 198 patients (125 Milan; 73 non-Milan) were enrolled in the current trial and 161 (81.3%) were transplanted at a median of 139 days within wait listing (112 Milan; 49 non-Milan). One, 5, and 8-year patients’ survival rates (Kaplan-Meier) were 88.6%, 82.7%, and 74.5%, respectively. When censoring for unrelated deaths, 1, 5 and 8-year survival rates were 98.9%, 89.3%, and 89.3% in Milan patients versus 95.6%, 85.9% and 85.9% in non-Milan patients (Cox regression p = 0.4). One, 5, and 8-year disease-free survival rates were 97%, 87.5%, and 87.5% in Milan patients versus 90.7%, 67%, and 67% in non-Milan patients (Cox regression p = 0.02). Conclusions: A policy of tumor down staging in association with patient prioritization based on clinical predictors may provide favorable results for HCC patients beyond the Milan criteria.

Liver transplantation for non-Milan HCC patients

De Simone P;Filipponi F
2006

Abstract

Aim: Liver transplantation (LT) for hepatocellular carcinoma (HCC)beyond the Milan criteria is still controversial. We investigated whether a policy of selective tumor down staging (DS) and patient prioritization based on clinical predictors might help improve the results of LT for non-Milan patients. Materials and methods: In January 1997 we set up a prospective trial on LT ± tumor down staging for consenting, adult patients affected with nodular-type HCC. Patients were down staged with either TACE, PEI, and/or RFA in the presence of: centrally-sited nodule(s), alpha-feto-protein serum levels ≥ 200 ng/ml, tumor grading ≥ G3, wait list times ≥ 3 months, and ineffective down staging while on wait list. Within the same UNOS status category patients were prioritized as follows: HCC > non-HCC; outside Milan > within Milan; centrally-sited > peripheral nodule(s), serum AFP levels, time on wait list, and ineffective > effective DS. Objective measures were: total patients enrolled; drop out rate; transplant rate; post-transplant recurrence rate, overall and disease-free survival rates. Data were analyzed within one year of last enrolment on an intent-to-treat basis. Results: Until October 2004 a total of 198 patients (125 Milan; 73 non-Milan) were enrolled in the current trial and 161 (81.3%) were transplanted at a median of 139 days within wait listing (112 Milan; 49 non-Milan). One, 5, and 8-year patients’ survival rates (Kaplan-Meier) were 88.6%, 82.7%, and 74.5%, respectively. When censoring for unrelated deaths, 1, 5 and 8-year survival rates were 98.9%, 89.3%, and 89.3% in Milan patients versus 95.6%, 85.9% and 85.9% in non-Milan patients (Cox regression p = 0.4). One, 5, and 8-year disease-free survival rates were 97%, 87.5%, and 87.5% in Milan patients versus 90.7%, 67%, and 67% in non-Milan patients (Cox regression p = 0.02). Conclusions: A policy of tumor down staging in association with patient prioritization based on clinical predictors may provide favorable results for HCC patients beyond the Milan criteria.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11568/893653
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