Many patients with liver cancer who don't meet criteria used to select transplant patients could actually be good candidates for liver transplantation, according to an Italian study.
The Milan criteria specifies that liver cancer patients with a single tumor of 5 centimeters or less in diameter, or three or fewer tumors, each no more than 3 cm in diameter and with no macrovascular invasion, can expect an excellent outcome after liver transplantation, with only a 10 percent risk of cancer recurrence.
Survival of patients who don't meet the criteria is unpredictable, and there are no evidence-based guidelines to help doctors select patients who exceed the criteria but might benefit from receiving a new liver, according to background information in the study.
Researchers at Italy's National Cancer Institute analyzed data from a Web survey of liver cancer specialists who provided information about 1,112 liver cancer patients who didn't meet the Milan criteria but had a liver transplant. In this group of patients, those without microvascular invasion had an overall five-year survival rate of 71 percent, similar to that of patients that meet the Milan criteria.
After studying this data, Dr. Vincenzo Mazzaferro and colleagues developed a new prognostic model that could be used to expand the Milan criteria and help identify patients whose odds of survival could be improved by having a liver transplant. In this "Up-to-seven" criteria, the seven refers to the maximum score based on adding the size (in centimeters) of the largest tumor to the total number of tumors.
"A more precise estimation of survival contouring individual tumor characteristics by use of the Up-to-seven criteria could replace the current dual [yes/no] approach to transplant candidacy based on the strict Milan criteria for patients with [liver cancer]," the researchers wrote.
The study was published online and in the January print issue of The Lancet Oncology.
More information
The American Liver Foundation has more about liver cancer.
SOURCE: The Lancet Oncology, news release, Dec. 4, 2008
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