Table 1.
Selection criteria for liver transplantation in hepatocellular carcinoma
| Criteria |
Definition
|
Overall survival, (%)
|
Comment
|
| Milan criteria (MC) (1996)[5] | Single tumor ≤ 5 cm | 75% (4-yr OS) | Gold standard |
| 2-3 tumors ≤ 3 cm | 92% (4-yr OS; inside MC at pathological examination) | Validated by many subsequent studies | |
| No macrovascular involvement | |||
| No extrahepatic disease | |||
| UCSF (2001)[28,163] | Single tumor ≤ 6.5 cm | 90% (1-yr OS) | Initial definition on pathological examination |
| 3 tumors all ≤ 4.5 cm with total tumor diameter ≤ 8 cm | 75% (5-yr OS) | ||
| Subsequently validated in preoperative imaging | |||
| Up-to seven (2009)[29] | Sum of the number of tumors and diameter of the largest tumor (in cm) ≤ 7 | 64% (beyond MC but within up-to-seven) | |
| Without microvascular invasion: 71% | |||
| With microvascular invasion 47% | |||
| Navarro criteria (2008)[32] | 1 tumor ≤ 6 cm | 92% (1-yr OS) | |
| 2-3 tumors ≤ 5 cm | 73% (5-yr OS) | ||
| Valencia criteria Silva et al[34] (2008) | Up to 3 tumors, each ≤ 5 cm, and a cumulative tumor burden ≤ 10 cm | 69% (5-yr OS) | |
| Recurrence probability: 12% and 28% after 1 and 5 yr, respectively | |||
| TTV (2008)[164] | TTV ≤ 115 cm3 | 80% (5-yr OS) | In some centers only LDLT for those beyond MC |
| AFP ≤ 400 ng/mL[165] | |||
| ETC (2011)[31] | No limits in size and number | 68% (beyond MC but inside ETC) | |
| No vascular invasion | 68% (5-yr OS)[37] | ||
| No extrahepatic disease | |||
| No cancer-related symptoms | |||
| Biopsy of the largest lesion not poorly differentiated | |||
| Asan criteria (2008)[33] | Largest tumor diameter ≤ 5 cm | 76% (5-yr OS) | LDLT |
| Number of HCC lesions ≤ 6 | |||
| No vascular invasion | |||
| Kyoto criteria (2007)[166] | Number of lesions ≤ 10 | Beyond MC but within Kyoto criteria: 65% 5-yr OS | LDLT |
| Size of the largest lesion ≤ 5 cm | |||
| 82% (5-yr OS)[38] | |||
| DCP ≤ 400 mAU/mL | |||
| Kyushu criteria (2011)[167,168] | Any number of tumors with a maximum diameter ≤ 5 cm | - 81% (5-yr OS)[169] | LDLT |
| DCP < 300 mAU/mL | |||
| Tokyo criteria 8 (5-5 rule)[30,35] | Up to 5 tumors | 80% (5-yr OS) | LDLT |
| Maximum diameter ≤ 5 cm | |||
| Samsung[170] | Maximum tumor size ≤ 6 cm | 90% RFS after 5 yr | LDLT |
| Number of tumors ≤ 7 | |||
| AFP ≤ 1000 ng/mL | |||
| 5-5-500[41] | Up to 5 tumors | - 76% (5-yr OS) | LDLT |
| Maximum diameter ≤ 5 cm- | |||
| AFP ≤ 500 ng/mL | |||
| Portal vein invasion | |||
| Seoul National University Hospital[43] | PV tumor thrombus does not extend into the main PV | 11 patients | LDLT |
| 64% (5-yr OS) | |||
| 46% (5-yr RFS) | |||
| AFP × DCP score ≤ 20000 Additional risk factors for recurrence: | |||
| Tumor size > 7 cm | |||
| Preop. FDG-PET SUV ratio ≥ 2.1 | |||
| Vp4 infiltration | |||
AFP: Alpha-fetoprotein; DCP: Des-γ-carboxy prothrombin; ETC: Extended Toronto criteria; FDG: Fluorodeoxyglucose; HCC: Hepatocellular carcinoma; LDLT: Living-donor liver transplantation; MC: Milan criteria; OS: Overall survival; PV: Portal vein; PET: positron emission tomography; RFS: Relapse-free survival; SUV: Standardized uptake value; TTV: total tumor volume; UCSF: University of California San Francisco.