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J Cancer Res Clin Oncol. 2009 Oct;135(10):1403-12. doi: 10.1007/s00432-009-0584-6. Epub 2009 Apr 21.

Liver transplantation outcomes in 1,078 hepatocellular carcinoma patients: a multi-center experience in Shanghai, China.

Author information

  • 1Liver Cancer Institute, Shanghai Medical School, Zhong Shan Hospital, Fudan University, 200032 Shanghai, People's Republic of China. jiafan99@yahoo.com

Abstract

PURPOSE:

To evaluate current selection criteria for patients undergoing liver transplantation (LT) in response to hepatocellular carcinoma (HCC), and to analyze the prognostic factors for successful transplantation.

METHODS:

We evaluated the outcome of 1,078 consecutive patients with HCC from the Shanghai Multi-Center Collaborative LT Group who underwent LT over a 6-year period. Clinicopathologic data for these patients were evaluated. The prognostic significance was assessed using Kaplan-Meier survival estimates and log-rank tests. Multivariate study with Cox's proportional hazard model was used to evaluate the prognosis-relative aspects.

RESULTS:

We determined that expansion of Milan criteria to include: a solitary lesion < or = 9 cm in diameter, no more than three lesions with the largest < or = 5 cm, a total tumor diameter < or = 9 cm without macrovascular invasion, lymph node invasion and extrahepatic metastasis (referred to as the "Shanghai criteria"), resulted in overall survival (OS) and disease-free survival (DFS) rates that were similar to the Milan criteria. Multivariate analysis using the Cox proportional hazards regression model showed that the Child-Pugh-Turcotte classification (P = 0.010, 0.000), tumor differentiation (P = 0.001, 0.000), tumor size (P = 0.000, 0.000) and number (P = 0.014, 0.016), macrovascular invasion (P = 0.022, 0.000) and alpha-fetoprotein (AFP) levels (P = 0.031, 0.003) were independent predictors of OS and DFS, while post-LT chemotherapy (OS, P = 0.000) and tumor encapsulation (DFS, P = 0.038) were independent predictors of OS or DFS.

CONCLUSION:

Shanghai criteria expanded the current criteria while maintaining similar survival.

PMID:
19381688
[PubMed - indexed for MEDLINE]
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