Hangzhou criteria as downstaging criteria in hepatocellular carcinoma before liver transplantation: A multicenter study from China

Zhan, Qifan; Ling, Sunbin; Deng, Yihui; Shan, Qiaonan; Ye, Qianwei; Xu, Shengjun; Jiang, Guangjiang; Lu, Di; Wei, Xuyong; Li, Zhuang; Zhang, Wu; Shen, Tian; Cen, Beini; Xie, Haiyang; Liu, Jimin; Wu, Jian; Zheng, Shusen; Yang, Yang; Xu, Xiao

doi:10.1016/j.hbpd.2020.06.011

Cited by 17 publications

(10 citation statements)

References 25 publications

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“…A Korean group created a revised scoring system based on tumor size, tumor number and pretransplant AFP levels (< or =20, 20.1 to 200, 200.1 to 1000, >1000 ng/mL), allowing an expansion for candidate selection without adverse outcomes 108 indicating the possibility of LT for those who were beyond MC but fulfilled the Hangzhou criteria and pointing out that AFP >100 ng/mL was an independent prognostic factor among them 13 . In some cases, the Hangzhou criteria was also considered as a downstaging criteria for HCC patients before LT to lower the threshold for LT 111 . Then, a team from Italy proposed a score containing AFP and TTD (the AFP-TTD score) but no histopathologic features, which simplified the Hangzhou criteria 112 .…”

Section: Afp With Tumor Morphologymentioning

confidence: 99%

The Landscape Of Alpha Fetoprotein In Hepatocellular Carcinoma: Where Are We?

Hu¹,

Chen²,

Wei³

et al. 2022

Int. J. Biol. Sci.

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Hepatocellular carcinoma (HCC) is the most common primary liver cancer and has been acknowledged as a leading cause of death among cirrhosis patients. Difficulties in early diagnosis and heterogeneity are obstacles to effective treatment, especially for advanced HCC. Liver transplantation (LT) is considered the best therapy for HCC. Although many biomarkers are being proposed, alpha-fetoprotein (AFP), which was identified over 60 years ago, remains the most utilized. Recently, much hope has been placed in the immunogenicity of AFP to develop novel therapies, such as AFP vaccines and AFP-specific adoptive T-cell transfer (ACT). This review summarizes the performance of AFP as a biomarker for HCC diagnosis and prognosis, as well as its correlation with molecular classes. In addition, the role of AFP in LT is also described. Finally, we highlight the mechanism and application prospects of two immune therapies (AFP vaccine and ACT) for HCC. In general, our review points out the prevalence of AFP in HCC, accompanied by some controversies and novel directions for future research.

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Section: Afp With Tumor Morphologymentioning

confidence: 99%

The Landscape Of Alpha Fetoprotein In Hepatocellular Carcinoma: Where Are We?

Hu¹,

Chen²,

Wei³

et al. 2022

Int. J. Biol. Sci.

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“…The RFS and OS of patients without MVI within the MC were the best survival [ 35 , 36 ]. Moreover, the HC can provide an ideal prognosis in comparison to the MC, give more patients access to LT, and serve as a demarcation for better or worse outcomes [37] . Further analysis of our results found that survival curves of RFS at the ZFA center proved that there was a significant difference in/beyond the MC with/without MVI in terms of different post-transplant outcomes.…”

Section: Discussionmentioning

confidence: 99%

A preoperative model for predicting microvascular invasion and assisting in prognostic stratification in liver transplantation for HCC regarding empirical criteria

Zhang

Liu

Chen

et al. 2021

Translational Oncology

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Highlights The predictive model used preoperatively accessible clinical parameters and radiographic features developed and validated by us to predict micro vascular invasion (MVI), based on a large sample, two Liver Transplantation (LT) centers observed 5 years among Hepatocellular Carcinoma (HCC) patients who underwent LT. This is the first study to report preoperative clinical variables and radiographic features for preoperative prediction of MVI among HCC patients undergoing LT. Prediction of the presence of MVI can help surgical decision-making and improve surgical management for HCC to further distinguish clinical outcomes.

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“…Several studies have not placed upper limits on the number and size of HCC nodules for downstaging. The only limits were the absence of vascular invasion and extrahepatic spread [ 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. A flaw of these studies is that the outcome analysis was not performed with the intention-to-treat purpose in most cases.…”

Section: Upper Limits For Downstaging?mentioning

confidence: 99%

“…Most of the published studies on downstaging have used the MC as a successful endpoint of downstaging. Recently, a retrospective multicentre study in China [ 67 ] investigated the endpoint of downstaging the Hangzhou Criteria (HC): (a) reduction in total tumour diameter ≤ 8 cm or (b) total tumour diameter > 8 cm with grade I or II tumour differentiation but AFP level ≤ 400 ng/mL. Successfully downstaged patients had OS and recurrence rates after transplantation comparable to those always within the HC, while the OS rates of patients downstaged to within the MC and within the HC were the same.…”

Section: Upper Limits For Downstaging?mentioning

confidence: 99%

Upper Limits of Downstaging for Hepatocellular Carcinoma in Liver Transplantation

Biolato

Galasso

Marrone

et al. 2021

Cancers

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In Europe and the United States, approximately 1100 and 1800 liver transplantations, respectively, are performed every year for hepatocellular carcinoma (HCC), compared with an annual incidence of 65,000 and 39,000 new cases, respectively. Because of organ shortages, proper patient selection is crucial, especially for those exceeding the Milan criteria. Downstaging is the reduction of the HCC burden to meet the eligibility criteria for liver transplantation. Many techniques can be used in downstaging, including ablation, chemoembolisation, radioembolisation and systemic treatments, with a reported success rate of 60–70%. In recent years, an increasing number of patient responders to downstaging procedures has been included in the waitlist, generally with a comparable five-year post-transplant survival but with a higher probability of dropout than HCC patients within the Milan criteria. While the Milan criteria are generally accepted as the endpoint of downstaging, the upper limits of tumour burden for downstaging HCC for liver transplantation are controversial. Very challenging situations involve HCC patients with large nodules, macrovascular invasion or even extrahepatic metastasis at baseline who respond to increasingly more effective downstaging procedures and who aspire to be placed on the waitlist for transplantation. This narrative review analyses the most important evidence available on cohorts subjected to “extended” downstaging, including HCC patients over the up-to-seven criteria and over the University of California San Francisco downstaging criteria. We also address surrogate markers of biological aggressiveness, such as alpha-fetoprotein and the response stability to locoregional treatments, which are very useful in selecting responders to downstaging procedures for waitlisting inclusion.

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Hangzhou criteria as downstaging criteria in hepatocellular carcinoma before liver transplantation: A multicenter study from China

Cited by 17 publications

References 25 publications

The Landscape Of Alpha Fetoprotein In Hepatocellular Carcinoma: Where Are We?

The Landscape Of Alpha Fetoprotein In Hepatocellular Carcinoma: Where Are We?

A preoperative model for predicting microvascular invasion and assisting in prognostic stratification in liver transplantation for HCC regarding empirical criteria

Upper Limits of Downstaging for Hepatocellular Carcinoma in Liver Transplantation

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