Overall survival of patients with hepatocellular carcinoma in lieu of transplant: A retrospective study comparing the Milan and San Francisco criterias.

Abstract

e14539 Background: Liver transplantation (LT) represents the beast treatment for hepatocellular carcinoma (HCC) showing a 70% 5- year survival rate. The Milan Criteria (MC) are often used for patient selection for LT. Expanded criteria for liver transplantation have been proposed for some centers. Our study compares overall survivals among patients who fit Milan Criteria (MC) or San Francisco Criteria (UCSFC) and had not undergone liver transplantation. Methods: All patients diagnosed with HCC at our institution from 2004 to 2009 were evaluated retrospectively. We analyzed age, gender, indication for orthotopic liver transplant (OLT), adjuvant treatments (chemotherapy, radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and liver resection) maximum tumor size and survival. Outcomes were compare for patients who met Milan Criteria ( single tumor < 5 cm, maximum of 3 total tumors with none > 3 cm) or University of California, San Francisco (UCSF) criteria ( single tumor < 6.5 cm , maximum of 3 total tumors with none > 4.5 cm, and cumulative tumor size < 8 cm) and were not under liver transplant. Results: From 2004 to 2009, a total of 194 patients were diagnosed with hepatocellular carcinoma in our institution. 61 patients (31%) had MC, and only 32 were eligible for OLT. 11 patients (5.6%) exceeded MC but fits UCSF criteria for OLT. A 5-year survival was 56% for the MC group versus 33% UCSF group. Hepatitis C virus was the most common etiology of HCC. Conclusions: Survival for patients with tumor beyond UCSF criteria was significantly lower and below 50% at 5 years, this important difference supports the use of expanded criteria to offer OLT as treatment for this group.