Objective: To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) and to explore the new criteria adapted for Chinese National Situation.
Methods: A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and January 2006 at our institution. We compared the outcome of the patients meeting different criteria such as milan, UCSF and the Pittsburgh modified TNM criteria. Survival rates were calculated using the Kaplan-Meier method, and differences between the curves were assessed by log-rank test.
Results: There was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates between milan criteria (n = 93; 86%, 77%, 77% and 91%, 86%, 86%) and UCSF criteria (n = 131; 90%, 83%, 83% and 92%, 89%, 89%). According to Pittsburgh criteria (n = 207), the 1, 2, 3-year survival rates and recurrence-free survival rates were 84%, 74%, 67% and 85%, 83%, 73%, respectively. For advanced tumors (over all the criteria), the survival rates and recurrence-free survival rates decreased significantly (n = 44; 65%, 43%, 43% and 47%, 43%, 43% respectively). When criteria (named as Shanghai Fudan Criteria) were expanded to HCC patients with solitary lesions < or = 9 cm in diameter, or no more than 3 lesions, the largest < or = 5 cm, with a total tumor diameter < or = 9 cm, there was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates (n = 151; 88%, 80%, 80% and 90%, 88%, 88%, respectively) as compared with milan criteria, but more patients using Shanghai Fudan Criteria could undergo liver transplantation.
Conclusion: Shanghai Fudan Criteria, which expanded the tumor size limits, does not adversely impact survival of HCC patients after LT.