Open AccessLiver Transplantation for Extended Criteria Hepatocellular Carcinoma Using Stable Response to Locoregional Therapy and Alpha-Fetoprotein as Selection Criteria
Author(s) -
Markus Bo Schoenberg,
H Anger,
Julian Nikolaus Bucher,
Gerald Denk,
Enrico N. De Toni,
Max Seidensticker,
Joachim Andrassy,
Martin K. Angele,
Jens Werner,
Markus Guba
Publication year - 2020
Publication title -
visceral medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.598
H-Index - 17
eISSN - 2297-475X
pISSN - 2297-4725
DOI - 10.1159/000506752
Subject(s) - hepatocellular carcinoma , medicine , milan criteria , liver transplantation , cohort , transplantation , selection (genetic algorithm) , gastroenterology , surgery , oncology , artificial intelligence , computer science
Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (IN MC ) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUT MC ) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology. Methods: OUT MC patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUT MC patients required (IN MUC ): (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with IN MC tumors served as control and internal validation cohort. Results: 31 of 170 liver transplant candidates were OUT MC . Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted IN MC compared to those OUT MC IN MUC (92.2% vs. 70.8%; p = 0.026) after 5 years of follow-up. Overall survival showed no significant difference ( p = 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the IN MC patients as internal validation cohort (c-index: 0.896; CI 0.588–0.981, p = 0.005). Conclusion: Dynamic selection criteria for the stratification of patients with OUT MC HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to IN MC patients.