Conventional criteria for liver transplantation for patients with hepatocellular carcinoma are 5 cm or less than or equal to 3 cm.
Dr Ravaioli and colleagues from Italy prospectively evaluated the possibility of slightly extending these criteria in a down-staging protocol, which included patients initially outside conventional criteria.
The team compared the outcome of patients down-staged to that of Milan criteria after liver transplantation and since the first evaluation according to an intention-to-treat principle.
From 2003 to 2006, 177 patients with hepatocellular carcinoma were considered for transplantation.
|The 1-year disease-free survival rate was 78% in the down-staging group|
|American Journal of Transplantation |
The team found that the transplantation rate was comparable between the Milan and down-staging groups, at 68% versus 67%, respectively.
The researchers noted that the 1 and 3 years' disease-free survival rates were comparable.
The 1 and 3 years' disease-free survival rates were 80% and 71% in the Milan group versus 78% and 71% in the down-staging group.
The actuarial intention-to-treat survival was 56% in the down-staging and 63% in the Milan group.
Dr Ravaioli’s team concluded, “The proposed down-staging criteria provide a comparable outcome to the conventional criteria.”