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Applicability of the Milan Criteria for Determining Liver Transplantation as a First-Line Treatment for Hepatocellular Carcinoma

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Abstract

Background

To determine whether or not the Milan criteria (MC) should be used to determine the applicability of liver transplantation (LT) as a first-line treatment for patients with cirrhosis with hepatocellular carcinoma (HCC) who are able to endure hepatectomy.

Methods

Retrospective analysis of 82 patients with cirrhosis with HCC who were treated by hepatectomy without LT at our institution between 1990 and 2003.

Results

Of these 82 patients, 48 met the MC. Proportional hazard regression analyses to determine the independent prognostic factors for postoperative cumulative patient and disease-free survival showed that meeting the MC is the strongest prognostic factor for both patient and disease-free survival. The cumulative patient and disease-free survival rates were 76.7% and 28.9%, respectively, at 5 years in patients who met the MC. The cumulative disease-free survival was markedly inferior to those in previously reported series of LT for HCC who met the MC, but the cumulative patient survival was comparable to those in the previously reported series. A comparison of cumulative postoperative survival between patients who met the MC and fulfilled all five factors listed below and patients who met the MC but did not fulfill any of the five factors demonstrated that the latter patients showed statistically significantly worse postoperative patient survival than the former. The five factors included: Model for End-Stage Liver Disease score <10, indocyanine green retention rate at 15 minutes <20%, absence of microscopic fibrous capsular invasion and microscopic intrahepatic metastases, and earlier grade (T1 or T2) of American Joint Committee on Cancer tumor classification.

Conclusions

The MC should not be used to determine the applicability of LT as a first-line treatment for patients with HCC considered able to endure hepatectomy. However, modifying MC with some clinicopathological factors could satisfy the appropriate criteria for applying LT as a first-line treatment for these patients.

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Acknowledgment

Supported in part by grants from the Yokohama City University Liver Transplant Indication Committee.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Daisuke Morioka MD, PhD, Kuniya Tanaka MD, PhD, Ken-ichi Matsuo MD, PhD, Kazuhisa Takeda MD, PhD, Michio Ueda MD, PhD, Mitsutaka Sugita MD, PhD, Yasuhiko Nagano MD, PhD, Itaru Endo MD, PhD, Hitoshi Sekido MD, PhD, Shinji Togo MD, PhD & Hiroshi Shimada MD, PhD

  2. Organ Transplant Unit, Kyoto University Hospital, 54, Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Daisuke Morioka MD, PhD

Authors
  1. Daisuke Morioka MD, PhD
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  2. Kuniya Tanaka MD, PhD
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  3. Ken-ichi Matsuo MD, PhD
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  4. Kazuhisa Takeda MD, PhD
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  5. Michio Ueda MD, PhD
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  6. Mitsutaka Sugita MD, PhD
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  7. Yasuhiko Nagano MD, PhD
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  8. Itaru Endo MD, PhD
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  9. Hitoshi Sekido MD, PhD
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  10. Shinji Togo MD, PhD
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  11. Hiroshi Shimada MD, PhD
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Correspondence to Daisuke Morioka MD, PhD.

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Morioka, D., Tanaka, K., Matsuo, Ki. et al. Applicability of the Milan Criteria for Determining Liver Transplantation as a First-Line Treatment for Hepatocellular Carcinoma. Ann Surg Oncol 13, 1500–1510 (2006). https://doi.org/10.1245/s10434-006-9204-8

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  • DOI: https://doi.org/10.1245/s10434-006-9204-8

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