Liver transplantation usually cures hepatocellular carcinoma when the Milan selection criteria are applied.
In this study Dr Myron Schwartz and colleagues used molecular data to identify patients who, although beyond the Milan criteria, had a favorable outcome.
The researchers analyzed the allelic imbalance of 18 microsatellites in 70 consecutive patients transplanted for hepatocellular carcinoma. Of these patients, 24 had recurrence and 46 survived at least 5 years recurrence-free.
The research team investigated fractional allelic imbalance, and relevant clinical and pathological variables for a correlation with time to recurrence.
|Allelic imbalance in 9 microsatellites correlated with recurrence.|
|Journal of Hepatology|
They determined that allelic imbalance in 9 microsatellites correlated with recurrence.
Furthermore, fractional allelic imbalance >0.27 and macrovascular invasion were independent predictors of recurrence in patients with tumors beyond Milan criteria.
Overall, the probability of recurrence at 5 years was 85% with a fractional allelic imbalance of 0.27 versus 10% when <0.27.
The team determined that an algorithm including Milan criteria and fractional allelic imbalance status was 89% accurate in predicting tumor recurrence after transplantation.
Dr Schwartz's team concluded, "Analysis of allelic imbalance of 9 microsatellites identifies a subgroup of patients who, despite having hepatocellular carcinoma beyond Milan criteria, have a low risk of posttransplant recurrence".