11/9/2023 0 Comments Hcc meat criteria![]() Intervention: LT adopting an expanded HCC-LT selection system Ĭomparison: LT adopting a standard selection approach (typically, the MC) Patient: patient with a confirmed HCC undergoing a LT The specific research question formulated in the present study included the following PICO components: ![]() The search strategy was performed following the preferred reporting items for systemic reviews and meta-analysis (PRISMA) guidelines. the expanded selection criteria.Ī systematic review of the published literature on the different HCC-LT selection systems developed was undertaken. Using the available data, a meta-analysis was also done to investigate the post-transplant recurrence rates reported using the MC vs. ![]() This paper aims to systematically review the different HCC-LT selection systems developed, with the intent to investigate their impact in terms of access to LT without compromising overall survival and oncological results. However, the co-existence of multiple scoring systems explains the heterogeneous treatment of HCC, leading to difficulties when interpreting short- and long-term outcomes, and access to LT varies widely among countries, continents, and allocation organizations. The search for 'the ideal' score was launched to give as many patients as possible access to a potentially curative oncological procedure without compromising outcomes. Conversely, many Eastern ones adopted a much more aggressive attitude fostered by the explosive development of living-donor-liver transplantation (LDLT). Many Western teams worked at a cautious extension of the inclusion criteria. However, after some years of stabilized practice, it became clear that the MC were too strict, denying access for many patients to potentially curative therapy. The MC became the international gold standard to select HCC patients for LT. A tumor load restricted to ≤ three tumors having a diameter ≤ 3 cm (Paris criteria) or one tumor ≤ 5 cm (Milan criteria, MC) resulted in 5-year disease-free survival (DFS) rates of 70–80%. The indication for LT moved from large multifocal lesions to a more limited tumor burden. The 'oncological pendulum' reversed in the nineties. Due to the lack of selection criteria, the concept of LT as the primary treatment of hepatobiliary malignancies was rapidly challenged because of the prohibitively high incidence of tumor recurrence. The child died after 400 days, during which time she underwent many reinterventions to treat both thoracic and abdominal tumor recurrences. The first 'successful' LT was performed on July 23, 1967, in a child presenting with a large hepatocellular cancer (HCC) in the context of biliary atresia. Thomas Starzl designed liver transplantation (LT) to treat unresectable primary and secondary hepatobiliary tumors. Further studies are needed to develop internationally accepted, expanded selection criteria for liver transplantation of HCC patients. The development of a widely accepted “comprehensive” HCC-LT Score able to offer a fair chance of justified transplantation to more patients should become a priority within the liver transplant community. A careful extension of the inclusion criteria should allow many more patients to access a potentially curative LT without compromising their outcome. Despite the increased number of LT, 5-year patient and disease-free survival rates were similar between MC-IN and MC-OUT/new HCC-LT-IN criteria. Overall, 31% more patients could be transplanted when adhering to the new HCC-LT selection systems. Among the 59 studies reporting HCC-LT selection systems, 15 (28.3%) were exclusively based on morphological aspects of the tumor 29 (54.7%) included biologic, seven (13.2%) radiological, and two (3.8%) only included pathological tumor features. A systematic review of the literature covering the period 1993 (date of the first reported HCC-LT selection system)–2021 identified 59 different inclusion criteria of HCC for LT. This paper aims to systematically review the different reported HCC-LT selection systems looking thereby at their ability to increase the number of transplantable patients and the overall survival and oncological outcome. Recently, several expanded criteria have been proposed to increase the transplantability of HCC patients without compromising their (oncologic) outcome. The Milan criteria (MC) remain the cornerstone for the selection of patients with hepatocellular cancer (HCC) to be listed for liver transplantation (LT).
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