Accuracy of Milan, University of California San Francisco, and Up-To-7 Criteria in Predicting Tumor Recurrence Following Deceased-Donor Liver Transplant in Patients With Hepatocellular Carcinoma

• Published in: Experimental and clinical transplantation Vol. 18; no. 4; pp. 463 - 469
• Main Authors: Saberi, Behnam, Garonzik-Wang, Jacqueline, Ma, Michelle, Ajayi, Tokunbo, Kim, Amy, Luu, Harry, Jakhete, Neha, Pustavoitau, Aliaksei, Anders, Robert A, Georgiades, Christos, Kamel, Ihab, Ottmann, Shane, Philosophe, Benjamin, Cameron, Andrew M, Gurakar, Ahmet
• Format: Journal Article
• Language: English
• Published: Turkey Başkent Üniversitesi 01.08.2020
• Subjects: Adult; Aged; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Decision Support Techniques; Female; Humans; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation - adverse effects; Male; Middle Aged; Neoplasm Recurrence, Local; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Tıp; Treatment Outcome; Ankara; Türkiye; Transplant eligibility; Explant pathology; Cancer recurrence
• ISSN: 1304-0855; 2146-8427
• DOI: 10.6002/ect.2017.0288

We aimed to investigate the accuracy of the Milan, University of California San Francisco, and Up-to-7 criteria in predicting tumor recurrence after liver transplant for hepatocellular carcinoma. For this study, 165 patients with deceased-donor liver transplant for hepatocellular carcinoma were evaluated. The Milan, University of California San Francisco, and Up-to-7 criteria were calculated based on explant pathology. Tumor recurrence rate after liver transplant was 14.6%. Of 165 patients, 115 (70%) were within Milan, 131 (79%) were within University of California San Francisco, and 135 (82%) were within Up-to-7 criteria. The odds ratio of tumor recurrence in patients outside versus within criteria for Milan, University of California San Francisco, and Up-to-7 was 3.6 (95% confidence interval, 1.5-9.1; P = .005), 7.5 (95% confidence interval, 2.5-19.3; P < .001), and 7.5 (95% confidence interval, 2.9-19.6; P < .001) times higher, respectively. The sensitivity of being outside of Milan in predicting tumor recurrence was comparable to University of California San Francisco and Up-to-7 criteria (56.5%, 56.5%, and 52.2%, respectively). Specificity was highest in Up-to-7 (87.3%) versus 85.2% for University of California San Francisco and 73.9% for Milan criteria. The area under the curve for Milan, University of California San Francisco, and Up-to-7 criteria was 0.63, 0.65, and 0.63. Application of standard criteria has significantly improved prediction of hepatocellular carcinoma recurrence. However, these criteria are inadequate, supporting the importance of other factors, including tumor biology. Research is ongoing in discovering novel biomarkers as predictors of tumor recurrence.