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Liver transplantation for hepatocellular carcinoma exceeding the Milan criteria: a single-center experience

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To establish a prognostic prediction system for patients with hepatocellular carcinoma (HCC) exceeding Milan criteria after liver transplantation (LT).


A total of 130 patients undergoing LT for HCC exceeding Milan criteria were enrolled into the study. Independent predictors for relapse-free survival (RFS) were adopted to establish a grading system to predict the risk of post-LT tumor recurrence.


Multivariate Cox analysis revealed that tumor size >10 cm [vs. ≤5 cm: relative risk (RR) = 4.214, P < 0.001], preoperative alpha fetoprotein > 400 ng/ml (vs. ≤400 ng/ml: RR = 1.657, P < 0.001), extrahepatic invasion (RR = 2.407, P = 0.005) and vascular invasion (RR = 1.917, P = 0.013) were independent predictors for RFS. The risk index of each patient was defined as the sum of the RR obtained in the Cox analysis for RFS. The risk of tumor recurrence was classified into four grades: grade I—risk index equal to 0, grade II—risk index from 0 to 2, grade III—risk index from 2 to 6 and grade IV—risk index >6. RFS rates of patients with grade I–IV (n = 35, 46, 30 and 19) were 87.5, 57.8, 34.7 and 0 % in 1 year; and 74.4, 41.7, 14.4 and 0 % in 5 years. Both of overall survival (OS) and RFS correlated well with the risk index grade. Patients with grade I achieved comparable prognostic outcomes with the Milan group patients (n = 119) (5-year OS = 73.7 vs. 74.7 %, P = 0.748; 5-year RFS = 74.4 vs. 85.7 %, P = 0.148).


The new grading system was proved to be a promising system in predicting the patient prognosis after LT for HCC exceeding Milan criteria.

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The study was supported by the Training Program for Superb Academic Leaders in Shanghai Health System (No. XBR2011029) and the Special Fund for Building of Leading Talent Teams in Shanghai.

Conflict of interest

We declare that we have no conflict of interest.

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Correspondence to Qiang Xia.

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Wan, P., Xia, Q., Zhang, J. et al. Liver transplantation for hepatocellular carcinoma exceeding the Milan criteria: a single-center experience. J Cancer Res Clin Oncol 140, 341–348 (2014). https://doi.org/10.1007/s00432-013-1576-0

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  • Liver transplantation
  • Hepatocellular carcinoma
  • Milan criteria
  • Survival
  • Recurrence
  • Prognosis