Table 2.
Extended criteria by adding the surrogate markers for biological behavior of HCC.
| Criteria | Author | Year | Institution | Criteria | Cases | Outcome | External Validation |
|---|---|---|---|---|---|---|---|
| Hangzhou | Zheng [10] | 2008 | Zhejiang University, China | Total tumor diameter less than or equal to 8 cm | 195 | Within Milan: 5-year survival rate: 78.3% | ◯ |
| Total tumor diameter more than 8 cm, with histopathologic grade I or II and preoperative AFP level less than or equal to 400 ng/mL | Within Hangzohu: 5-year survival rate: 72.3% | ||||||
| Toronto | Dubay [11] | 2011 | Univ. of Toronto, Canada | No vascular invasion on imaging studies | 294 | Within Milan: 5-year survival rate: 72% | |
| HCC is confined to the liver, and not poorly diffentiated on biopsy. | Within Tronto: 5-year survival rate: 70% | ||||||
| AFP model | Duvoux [13] | 2012 | French Study group, France | HCC size (cm): ~3 (0)/3.1~6 (1)//6.1~ (4) | 537 | Less than score 2: 5-year survival rate: 70% | ◯ |
| Number of HCC: ~3 (0)/4~ (2) | 435 (validation) | ||||||
| AFP (ng/mL): ~100 (0)/101~1000 (2)/1001~ (3) | |||||||
| TTV+AFP | Toso [17] | 2015 | Univ. of Alberta, Canada | TTV less than 115 cm3 | 233 | Within TTV/AFP but beyond Milan: 4-year survival rate: 74.6% | |
| AFP less than 400 ng/mL | |||||||
| Metroticket 2.0 model | Mazzaferro [18] | 2018 | Multicenter, Italy | Up-to-7 & AFP < 200 ng/mL | 1018 | 5-year survival rate: 79.7% | ◯ |
| Fudan Univ., Chila | Up-to-5 & AFP 200–400 ng/mL | 341 (validation) | |||||
| Up-to 4 & APP 400–1000 ng/mL | |||||||
| AP criteria | Todo [20] | 2007 | Multiceter, Japan | AFP (<200 ng/mL) and PIVKA-II (<100 mAU/mL) to the Milan criteria | 653 | 5-year survival rate: 82.0% | |
| Kyoto | Takada [22] | 2007 | Univ. of Kyoto, Japan | Maximum diameter of < 5 cm, <10 tumors, and PIVKA-II < 400 mAU/mL | 136 | 5-year survival rate: 87% | ◯ |
| Kyushu | Shirabe [23] | 2011 | Univ. of Kyushu, Japan | PIVKA-II < 300 mAU/mL, regardless of the number of tumors, as long as it is less than 5 cm in diameter | 109 | 5-year disease free survival rate: 80% | |
| MoRAL score | Lee [25] | 2016 | Multicenter, Korea | MoRAL Score (11 × √PIVKA-II + 2 × √AFP) < 314.8 | 566 | Low Moral but beyond Milan: 5-year survival rate: 82.6% | ◯ |
| Japan | Shimamura [26] | 2019 | Multicenter, Japan | Nodule size < 5 cm in diameter, nodule number < 5, and AFP < 500 ng/mL | 965 | Within 5-5-500: 5-year overall survival rate: 75.8% | |
| Within Milan or 5-5-500: 5-year survival rate: 74.8% |
◯: Externally validated.