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Abstract

Hepatocellular carcinoma is the most common primary liver malignancy. Liver transplantation has been a successful therapy for selected patients with hepatocellular carcinoma. Since 1996, Milan criteria have been universally recognized as the guidelines for selecting patients with hepatocellular carcinoma for orthotopic liver transplantation. However, the simple use of tumor size and number has been insufficient to indicate the biologic features of hepatocellular carcinoma and to predict the risk of tumor recurrence. The Milan criteria are quite strict because their rules can cause patients to be excluded from wait lists who could in fact benefit from transplant. Therefore, many expanded criteria are now incorporating different biologic markers, such as alpha-fetoprotein. 18F-fluorodeoxyglucose positron emission tomography-computed tomography could be a helpful diagnostic tool to decide the most suitable therapy, particularly for patients with hepatocellular carcinoma beyond the Milan criteria. Patients initially beyond Milan criteria can be downstaged to reduce tumor size to fulfill Milan criteria. Locoregional therapies are used for down staging, including transarterial chemoembolization, radiofrequency ablation, and percutaneous ethanol injection. Good responses to downstaging therapy and then waiting at least 3 months after locoregional therapy to reevaluate the decision of liver transplantation for patients with hepatocellular carcinoma beyond Milan criteria can result in better survival rates in these patients. Sorafenib and mammalian target of rapamycin inhibitors are promising agents for reducing tumor recurrence rate after liver transplantation. With cautious patient selection criteria and the use of locoregional therapy before liver transplantation, good results can be obtained for patients beyond Milan criteria who had no better chance other than liver transplant.

Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

“…Manini et al[ 28 ] showed the efficacy of DEB-TACE for treatment of BCLC A stage HCC patients prior to liver transplantation based on the Milan criteria[ 29 ]. The median diameter of the target tumors was 24 mm, similar to that in our study, and achieving CR with initial DEB-TACE was found to be an important prognostic factor.…”

Ubenimex suppresses Pim-3 kinase expression by targeting CD13 to reverse MDR in HCC cells

“…Surgical ablation is the most effective method for localized HCC with Child-Pugh A or B and a single tumor diameter <5 cm [ 29 ]. Liver transplantation is considered to be an effective method for the treatment of patients with end-stage liver disease or primary liver cancer, but preventing the recurrence of HCC after transplantation and improving the survival rate of patients remains a challenge [ 30 ]. In recent years, small molecule drugs targeting epidermal growth factor receptor, vascular endothelial growth factor and multiple amino acid kinase have been gradually applied to the clinical treatment of patients with HCC.…”

Microvascular Invasion in HCC: The Molecular Imaging Perspective

“…These criteria take in account the morphological parameters such as size and number of nodules (one lesion smaller than 5 cm or, alternatively, up to three lesions, each smaller than 3 cm), with diagnostic imaging techniques like contrast CT and MRI that act as main tools used to reach diagnosis and prognostic evaluation of HCC [ 6 ]. Nonetheless, more recently, MC have been criticized because they appear over conservative, thus refraining a significant number of patients from a possible curative treatment [ 7 ]. In this sense, nowadays, it is generally accepted that MC cutoffs have to be extended in order to increase the number of HCC patients eligible for LT [ 8 ].…”