Liver transplantation for hepatocellular carcinoma beyond the Milan criteria: A review

Table 1 Selection criteria in different centers for hepatocellular carcinoma beyond the Milan criteria

Criteria	Year	Country	Sample size		Contents of criteria	Survival (5-yr)
			DDLT	LDLT		OS	RFS
UCSF[7]	2001	America	70	0	Tumor ≤ 6.5 cm, or ≤ 3 nodules with the largest ≤ 4.5 cm and a total tumor ≤ 8 cm	75.2%	None
Up-to-7[8]	2009	Italy	1404	121	The sum of the tumor number and the size of the largest tumor no larger than 7 cm	71.2%	None
Tokyo[9]	2007	Japan	0	78	Tumors no larger than 5 cm and no more than 5 nodules	75.0%	94% (3-yr)
Hangzhou[12]	2008	China	195	0	Tumor ≤ 8 cm, or tumor > 8 cm, histopathologic grade I or II and preoperative AFP ≤ 400 ng/mL	78.3%	62.4%
Kyoto[6]	2007	Japan	0	125	Tumor ≤ 10 nodules, all ≤ 5 cm and a serum DCP level ≤ 400 mAU/mL	86.7%	None
Shanghai[14]	2009	China	1074	4	Tumor ≤ 9 cm, or ≤ 3 lesions with the largest ≤ 5 cm, tumor ≤ 9 cm without macrovascular and lymph node invasion and extrahepatic metastasis	78.1%	52.6%
Asan[11]	2008	South Korea	0	221	Tumor ≤ 5 cm in diameter, ≤ 6 in nodule number, and free of gross vascular invasion	81.6%	None

UCSF: University Of California San Francisco; LDLT: Living donor liver transplantation; DDLT: Deceased donor liver transplantation; OS: Overall survival; RFS: Relapse free survival.

Table 2 Tumor markers and the cut-off of different selection criteria

Markers	Authors	Cut-off	Other content	Survival (5-yr)
				OS	RFS
AFP	Zheng et al[12]	AFP ≤ 400	Hangzhou criteria	78.3%	62.4%
	Toso et al[27]	AFP ≤ 400	Total tumor volume ≤ 115 cm3	None	None
	Wan et al[20]	AFP ≤ 400	Tumor ≤ 10 cm, no vascular and extrahepatic invasions	73.7%	74.4%
DCP	Ito et al[6]	DCP ≤ 400	Tumor size ≤ 10 cm	86.7%	None
	Soejima et al[13]	DCP ≤ 300	Tumor size ≤ 5 cm	None	93.8% (3-yr)
NLR	Xiao et al[43]	NLR < 4	None	61.5%	60.7%
AFP/CA199	Wan et al[30]	AFP ≤ 400, CA199 ≤ 400	None	74.6%	78.5%
NLR/CRP	Na et al[47]	NLR < 6.0 or CRP < 1.0	None	None	None
DCP/AFP	Todo et al[35]	DCP ≤ 100, AFP ≤ 200	Milan criteria	None	96.4%
	Shindoh et al[36]	AFP ≤ 250, DCP ≤ 450	Tokyo criteria	84.0%	96.8%

AFP: Alpha fetoprotein; DCP: Des-Gamma-carboxy prothrombin; NLR: Neutrophil-to-lymphocyte ratio; OS: Overall survival; RFS: Relapse free survival.