Tumor Burden Predictive of Survival and Recurrence after Liver Transplant: Presented at AASLD

By Crystal Phend

November 21, 2005

SAN FRANCISCO -- Patients with a tumor burden meeting Milan criteria for organ allocation have better outcomes after liver transplantation than do those who exceed the criteria, according to a study presented here at the annual meeting of the American Association for the Study of Liver Diseases (AASLD).

"Some have suggested expansion of the Milan criteria because they have been too restrictive," said lead author Soojong Hong, MD, Resident, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States.

The Milan criteria allow for a single lesion <5 cm or fewer than three nodules (each <3 cm), a total tumor burden of 5.8.

Dr. Hong and colleagues examined a retrospective group of 108 patients awaiting liver transplantation due to hepatocellular carcinoma from 1997 to 2005. He presented his findings on November 14^th.

Most had hepatitis C virus (61%) and 84% met Milan criteria. The average size of the main nodule was 3.1 cm by radiology and 2.8 cm by explant. The average number of tumors was 1.6 according to radiology and 1.9 by explant.

The total tumor burden was obtained at diagnosis of hepatocellular carcinoma using Response Evaluation Criteria in Solid Tumors. The median total burden was about 5 cm.

Overall survival was 86% at 1 year, 70% at 3 years and 52% at 5 years.

Patients whose total tumor burden met the Milan criteria had a significantly higher survival probability than those who exceeded the criteria.

Of the 74 patients who received a liver transplant during the study period, recurrence rates was significantly lower for the patients whose total tumor burden met the criteria.

Total tumor burden was the sole independent predictor of survival and the only independent predictor of recurrence, Dr. Hong said. Patients whose tumor burden exceeded Milan criteria had an 18-fold increased risk of recurrence.

Dr. Hong concluded that due to the current shortage of cadaveric organs, adhering to Milan criteria leads to excellent outcomes. However, he acknowledged that recent studies have shown some patients who do not meet the criteria can achieve good outcomes.

"Further studies should evaluate which patients with tumor burdens that exceed the criteria would benefit from liver transplantation," Dr. Hong said.

Presentation title: Total Tumor Burden Is Predictive of Survival and Recurrence After Liver Transplantation for Hepatocellular Carcinoma: A Caution for Expansion of Milan Criteria. Abstract 105.

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This article posted December 13, 2005.