Recurrence after liver transplantation for hepatocellular carcinoma according to up-to-seven criteria

摘要

Background/Aims: The Up7 criteria for HCC have recently emerged to identify potential candidates for OLT. The aim of this study was assessing the validity of the Up7 criteria according to the pathological analysis of the explanted livers. Methodology: For recurrence risk calculation the 669 HCC transplanted patients were classified according to both the pathological Milan and Up7 criteria. In order to identify potential predictors of recurrence, selected biological tumor markers and morphological features were then tested by Cox regression. Results: The 5-year HCC recurrence rate for the "Milan out/Up7 in" subgroup (n=87), was significantly higher than patients meeting Milan criteria (n=299), 15.8% vs. 9.4% (p 0.0290). For patients within the Up7 criteria (n=383), only pre-OLT AFP level>1000 ng/ml and microvascular invasion were significant predictors for recurrence, and for those beyond the Up7 criteria (n=286), pre-OLT AFP level>1000 ng/ml, poor differentiation grade and microvascular invasion remained significant. Conclusions: Compared to the current Milan staging system, HCC patients within the pathological Up7 criteria were associated with a higher, but acceptable risk of recurrence after OLT, and along with tumor burden, others parameters can potentially be used for further refinement of HCC staging, such as AFP levels and microvascular invasion. We conducted this present work in France to assess on a multicentric series of patients transplanted for HCC the validity of the up-to-seven criteria based on the pathological analysis of the explanted livers, in order to encourage future larger randomized trials.