Expanded Criteria for Hepatocellular Carcinoma Through Down-Staging Prior to Liver Transplantation: Not Yet There

Josep M. Llovet; Myron Schwartz; Josep Fuster; Jordi Bruix

doi:10.1055/s-2006-947296

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2006; 26(3): 248-253
DOI: 10.1055/s-2006-947296

Expanded Criteria for Hepatocellular Carcinoma Through Down-Staging Prior to Liver Transplantation: Not Yet There

Josep M. Llovet¹ ^, ² , Myron Schwartz¹ , Josep Fuster² , Jordi Bruix²

¹Mount Sinai Liver Cancer Program (Divisions of Liver Disease and Recanati Miller Transplantation Institute, Department of Surgery), Mount Sinai School of Medicine, New York, New York
²Barcelona-Clínic Liver Cancer (BCLC) Group, IDIBAPS, Liver Unit, Hospital Clinic, Barcelona, Spain

Abstract

ABSTRACT

The accepted treatment strategy for hepatocellular carcinoma (HCC) is supported by randomized controlled trials (RCTs), meta-analysis, and large cohort studies. For instance, the Milan criteria applied for indicating liver transplantation have been validated by several cohort studies including more than 1000 patients. Regarding medical treatments, approximately 80 RCTs have been published so far in HCC. These studies provide the evidence to support chemoembolization as the treatment for patients at intermediate stage (meta-analysis of 6 RCTs) and show the lack of benefit of tamoxifen assessed in 12 RCTs including more than 1500 patients. In this scenario, what is the evidence to advocate for the expansion of HCC criteria through down-staging prior to liver transplantation? Such an approach has never been tested through RCTs or even well-designed cohort studies including enough patients and adequate follow-up. Only a few small studies with heterogeneous target populations and treatments applied are available. The results of these studies are inconsistent and do not provide compelling evidence to accept down-staging as a standard of care.

KEYWORDS

Hepatocellular carcinoma - liver transplantation - waiting list - down-staging - dropout - expansion of criteria

Full Text

References

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Josep M LlovetM.D.

Division of Liver Diseases, Mount Sinai School of Medicine

1425 Madison Avenue, 11F-70, Box 1104, New York, NY 10029