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Semin Liver Dis 2021; 41(02): 117-127
DOI: 10.1055/s-0040-1716565
Review Article

The Key Role of Staging Definitions for Assessment of Downstaging for Hepatocellular Carcinoma

Francis Y. Yao
1   Division of Gastroenterology, Department of Medicine, University of California, San Francisco
,
Nicholas Fidelman
2   Division of Interventional Radiology, Department of Radiology, University of California, San Francisco
,
Neil Mehta
1   Division of Gastroenterology, Department of Medicine, University of California, San Francisco
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Abstract

The success of liver transplant (LT) for hepatocellular carcinoma (HCC) is dependent on accurate tumor staging using validated imaging criteria, and adherence to acceptable criteria based on tumor size and number. Other factors including α-fetoprotein (AFP) and response to local regional therapy (LRT) have now played a larger role in candidate selection. Tumor downstaging is defined as reduction in the size of viable tumors using LRT to meet acceptable criteria for LT, and serves as a selection tool for a subgroup of HCC with more favorable biology. The application of tumor downstaging requires a structured approach involving three key components in tumor staging—initial tumor stage and eligibility criteria, tumor viability assessment following LRT, and target tumor stage prior to LT—and incorporation of AFP into staging and treatment response assessments. In this review, we provide in-depth discussions of the key role of these staging definitions in ensuring successful outcome.

Keywords

hepatocellular carcinoma - downstaging - liver transplant - local regional therapy - α-fetoprotein


Publication History

Article published online:
14 January 2021

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