Comparative analysis of patients transplanted due to hepatocellular carcinoma. Are there survival differences between those who meet the Milan criteria and those who exceed them?
Introduction and aim: The Milan criteria have been the subject of discussion in recent years due to their restrictive nature. Expansion of the criteria and the use of locoregional therapies to downstage patients and increase the number of transplant candidates have been proposed. Our study analyzed...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-01-01
|
| Series: | Revista de Gastroenterología de México (English Edition) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2255534X2500012X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Introduction and aim: The Milan criteria have been the subject of discussion in recent years due to their restrictive nature. Expansion of the criteria and the use of locoregional therapies to downstage patients and increase the number of transplant candidates have been proposed. Our study analyzed the results of patients that underwent transplant due to hepatocellular carcinoma, comparing those that met the Milan criteria and those that exceeded them. Materials and methods: A retrospective, observational, single-center study was conducted on liver transplantations due to hepatocellular carcinoma, within the time frame of 2010−2021. Demographic and clinical variables, overall survival, and disease-free survival were analyzed. The Student’s t test or Mann–Whitney U test were applied for the quantitative variables and the Fisher’s exact test for the categorical variables. The survival function was estimated through the Kaplan–Meier method and the log-rank test was applied for comparing the groups. Results: Of the 96 transplanted patients, 78 met the Milan criteria and 18 exceeded them. Patients that did not meet the Milan criteria had a higher number of nodules (1.6 vs. 3.5 nodules; p = 0.000), larger main lesions (24.38 vs. 38.55 mm; p = 0.000), a higher bilobar hepatocellular carcinoma rate (21.79% vs. 72.22%, p = 0.000), and higher tumor burden. There were no significant differences regarding overall survival, but there was a lower rate of disease-free survival in the group exceeding the criteria. Conclusion: Downstaged patients that received locoregional therapies had lower disease-free survival rates than patients that met the Milan criteria, but there were no significant differences regarding overall survival. Resumen: Introducción y objetivos: Los criterios de Milán han sido discutidos debido a su carácter restrictivo. Se ha propuesto su ampliación, y el empleo de terapias locorregionales que infraestadifiquen y aumenten los candidatos a trasplante. Nuestro estudio analiza los resultados de los pacientes trasplantados por carcinoma hepatocelular que cumplían criterios de Milán y aquellos que los excedían. Materiales y métodos: Estudio observacional, retrospectivo y unicéntrico sobre trasplantados hepáticos por carcinoma hepatocelular entre el 2010−2021. Se analizaron variables demográficas, clínicas y supervivencia global y libre de enfermedad. Se aplicó la prueba t-Student o la de U de Mann-Whitney para variables cuantitativas; para categóricas el test exacto de Fisher. Se estimó la función de supervivencia mediante el método de Kaplan-Meier y se aplicó el log rank para comparar entre grupos. Resultados: De los pacientes 96 trasplantados, 78 cumplían criterios de Milán y 18 los excedían. Los pacientes que no cumplían los criterios de Milán presentaban mayor número de nódulos (1,6 vs. 3,5 nódulos (p = 0,000)), mayor tamaño de las lesiones principales (24,38 vs. 38,55 mm, p = 0,000) y mayor tasa de carcinoma hepatocelular bilobular (21,79% vs. 72,22%, p = 0,000), así como mayor carga tumoral. No hubo diferencias significativas en cuanto a la supervivencia global, aunque sí en cuanto a la supervivencia libre de enfermedad, siendo menor en el grupo que excedía los criterios. Conclusión: Los pacientes infraestadiados con terapias locorregionales presentan tasas de supervivencia libre de enfermedad menores a los pacientes que cumplen los criterios de Milán, sin diferencias significativas en cuanto a la supervivencia global. |
|---|---|
| ISSN: | 2255-534X |