Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

Germani, Giacomo; Gurusamy, Kurinchi Selvan; Garcovich, Matteo; Toso, Christian; Fede, Giuseppe Di; Hemming, Alan W.; Suh, Kyung‐Suk; Weber, Achim; Burroughs, Andrew K.

doi:10.1002/lt.22336

Cited by 66 publications

(62 citation statements)

References 79 publications

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“…13,23,24 In a recent metaanalysis of 74 studies by Germani and associates, the authors found that patients receiving LT beyond the Milan criteria have increased risk of recurrence and worse overall survival, which includes an increased risk of death if transplanted outside the Milan criteria, but within the more inclusive UCSF criteria. 25 Therefore, relaxing the tight parameters defined in the Milan criteria on pre-LT tumor size adversely affects post-LT outcomes.…”

Section: Pretransplant-prevention Of Hepatocellular Carcinoma Recurrementioning

confidence: 99%

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Rubin

Ayoub²,

Kaldas³

et al. 2012

Exp Clin Transplant

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Hepatocellular carcinoma is the most common form of liver cancer, representing 70% to 85% of primary hepatic malignancies in adults. Liver transplant is an optimal treatment for patients with hepatocellular carcinoma because it eliminates the malignancy as well as the oftenunderlying liver cirrhosis and restores normal liver function. Since the development of strict selection criteria in hepatocellular carcinoma patients undergoing liver transplant with the implementation of the Milan criteria, patient survival and recurrence rates after liver transplant have dramatically improved. However, several research groups are now seeking to expand this criteria to include more patients with larger tumors who may achieve similar postliver transplant survival rates as those patients meeting current eligibility requirements. Currently, in approximately 20% of patients, hepatocellular carcinoma recurrence is still the rate-limiting event that clearly affects patient survival.Given the limited number of grafts available for transplant, the poor prognosis of untreated hepatocellular carcinoma, and the recent notion of expanding selection criteria, strategies for reducing the rate of, monitoring and treating hepatocellular carcinoma recurrence, in both pretransplants and posttransplants, are explored in this review. We review the available literature to better understand current strategies available to optimize long-term clinical outcomes.

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Section: Pretransplant-prevention Of Hepatocellular Carcinoma Recurrementioning

confidence: 99%

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Rubin

Ayoub²,

Kaldas³

et al. 2012

Exp Clin Transplant

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“…Among morphologic criteria, whether size, number, or total volume is more relevant for selection remains unresolved. A recently reported meta-analysis [57] studied recurrence and survival data in patients who underwent LT for HCC with reference to the size and number of tumor data available before LT. Patients with total tumor diameter (T total ) ≥10 cm have a probability of OS 1/5 compared to those with T total <10 cm, and those with T total ≥9 cm have 1/2 probability of DFS as compared to those with T total <9 cm.…”

Section: Biopsy: Is It Necessary?mentioning

confidence: 99%

Liver Transplantation for HCC: A Review

Kakodkar¹,

Soin²

2011

Indian J Surg

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Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease or cirrhosis. Liver transplantation for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Limitations in organ availability, necessitate stringent selection of patients who would likely to derive most benefit. Selection criteria have considered tumor size, number, volume as well as biological features. The Milan criteria set the benchmark for tumors that would benefit from liver transplantation but were found to be excessively restrictive. Modest expansion in criteria has also been shown to be associated with equivalent survival. Microvascular invasion is the single most important adverse prognostic factor for survival. Living donor liver transplantation has expanded donor options and has the advantage of lower waiting period and not impacting the non-HCC waiting list. Acceptable outcomes have been obtained with living donor liver transplantation for larger and more numerous tumors in the absence of microvascular invasion. Downstaging of tumors to prevent progression while waiting for an organ or for reduction in size to allow enrolment for transplantation has met with variable success.

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“…Additionally 10% to 15% nodules suspected to harbor HCC on pre-transplant imaging are reported benign following microscopic scrutiny of resection specimens by histopathologists [11]. As a result, any policy of complete reliance on pre-transplant imaging for assessing tumor morphology is far from infallible.…”

mentioning

confidence: 99%

Inappropriate inferences from registry data: Pitfalls of inaccurate data handling?

Kakodkar¹

2017

Indian J Gastroenterol

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Which matters most: Number of tumors, size of the largest tumor, or total tumor volume?

Cited by 66 publications

References 79 publications

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Liver Transplantation for HCC: A Review

Inappropriate inferences from registry data: Pitfalls of inaccurate data handling?

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