Recent advances in the surgical treatment of hepatocellular carcinoma

Table 3 Summary of recent advances in liver transplantation for hepatocellular carcinoma

	Established	Under discussion	Under trial or proposal
Criteria for listing candidate	The Milan criteria: Solitary tumor of ≤ 5 cm or up to 3 nodules ≤ 3 cm 5-yr survival of 70% with recurrence in less than 10%	The UCSF criteria: Single tumors ≤ 6.5 cm or 2–3 tumors ≤ 4.5 cm, with a total tumor diameter ≤ 8 cm	Add parameters for biologic features of tumors related to risk of recurrence (AFP, PIVKA-II, etc.) Expansion of criteria for living donor-LT
Management on the waiting list (about 40% dropout rate at 12 mo)	Local ablation therapy and TACE are performed without solid evidence	Different models have been developed to quantify the risk of death in neoplastic and non-neoplastic patients Association with liver resection: "bridging resection" to transplantation and "salvage transplantation" following resection	Application of living donor-LT to shorten the waiting time Candidate selection with information from precedent therapy (histologic specimen, response to locoregional therapy, etc.)

AFP: α-fetoprotein; PIVKA: Protein induced by vitamin K absence; LT: Liver transplantation; TACE: Transarterial chemoembolization; UCSF: University of California, San Francisco; HCC: Hepatocellular carcinoma.