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Intention-to-treat analysis of liver transplantation in selected, aggressively treated HCC patients exceeding the Milan criteria.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2007 Apr; Vol. 7 (4), pp. 972-81. - Publication Year :
- 2007
-
Abstract
- This prospective study analyzed the dropout probability and intention-to-treat survival rates of patients with hepatocellular carcinoma (HCC) selected and treated according to our policy before liver transplantation (LT), with particular attention to those exceeding the Milan criteria. Exclusion criteria for LT were macroscopic vascular invasion, metastases, and poorly differentiated disease at percutaneous biopsy. A specific multi-modal adjuvant algorithm was used to treat HCC before LT. A total of 100 HCC patients were listed for LT: 40 exceeded the Milan criteria in terms of nodule size and number (MILAN OUT) either at listing or in list, while 60 patients continued to meet the criteria (MILAN IN). The Milan criteria did not prove to be a significant predictor of dropout probability or survival rates using Cox's analysis. Cumulative dropout probability at 6 and 12 months was 0% and 4% for MILAN OUT, and 6% and 11% for MILAN IN. The intention-to-treat survival rates at 1 and 3 years were 95% and 85% in MILAN OUT, and 84% and 69% in MILAN IN. None of the 68 transplanted patients had recurrent HCC after a median 16-month follow-up (0-69 months). In conclusion, LT may be effective for selected, aggressively-treated HCC patients exceeding the Milan criteria.
- Subjects :
- Adult
Aged
Algorithms
Biopsy
Carcinoma, Hepatocellular pathology
Female
Humans
Italy
Liver Neoplasms pathology
Liver Neoplasms therapy
Liver Transplantation mortality
Male
Middle Aged
Neoplasm Staging
Patient Selection
Probability
Prospective Studies
Survival Analysis
Waiting Lists
Carcinoma, Hepatocellular surgery
Liver Neoplasms surgery
Liver Transplantation statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6135
- Volume :
- 7
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 17391137
- Full Text :
- https://doi.org/10.1111/j.1600-6143.2006.01719.x