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

@article{citeulike:6039627, abstract = {We previously proposed modified staging criteria for predicting acceptable outcome after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). These were solitary tumor le6.5 cm, or three or fewer nodules with the largest lesion le4.5 cm and total tumor diameter le8 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 le5 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 ge70\%, 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.}, address = {Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Pathology, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Surgery, University of California, San Francisco, San Francisco, CA}, author = {Yao, Francis Y. and Ferrell, Linda and Bass, Nathan M. and Bacchetti, Peter and Ascher, Nancy L. and Roberts, John P.}, citeulike-article-id = {6039627}, citeulike-linkout-0 = {http://dx.doi.org/10.1053/jlts.2002.34892}, citeulike-linkout-1 = {http://www3.interscience.wiley.com/cgi-bin/abstract/106593603/ABSTRACT}, doi = {10.1053/jlts.2002.34892}, issn = {1527-6473}, journal = {Liver Transplantation}, keywords = {hcc\_liver\_transplantation}, number = {9}, pages = {765--774}, posted-at = {2009-10-30 02:36:41}, priority = {2}, title = {Liver transplantation for hepatocellular carcinoma: Comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria}, url = {http://dx.doi.org/10.1053/jlts.2002.34892}, volume = {8}, year = {2002} }

TY - JOUR ID - citeulike:6039627 L3 - citeulike-article-id:6039627 N2 - We previously proposed modified staging criteria for predicting acceptable outcome after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). These were solitary tumor le6.5 cm, or three or fewer nodules with the largest lesion le4.5 cm and total tumor diameter le8 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 le5 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 ge70%, 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. IS - 9 JF - Liver Transplantation SN - 1527-6473 AD - Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Pathology, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Surgery, University of California, San Francisco, San Francisco, CA EP - 774 TI - Liver transplantation for hepatocellular carcinoma: Comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria VL - 8 SP - 765 KW - hcc_liver_transplantation AU - Yao, Francis AU - Ferrell, Linda AU - Bass, Nathan AU - Bacchetti, Peter AU - Ascher, Nancy AU - Roberts, John PY - 2002/// UR - http://dx.doi.org/10.1053/jlts.2002.34892 ER -