Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

Table 1 Downstaging and bridging protocol

Downstaging and bridging protocol
Inclusion Criteria
Bridging
	Patients who were within MC or UNOS T2
Downstaging subgroups (HCC exceeding MC)
	Group 1 = 1 lesion > 5 and ≤ 8 cm
	Group 2 = 2 or 3 lesions at least one > 3 and ≤ 5 cm with the sum of the maximal tumor diameters ≤ 8 cm
	Group 3 = 4 or 5 lesions each ≤ 3 cm with the sum of the maximal tumor diameters ≤ 8 cm
	Group 4 = 2 or 3 lesions at least one > 5cm with the sum of the maximal tumor diameters ≤ 8 cm
	Group 5 = total tumor diameter > 8 cm
	Absence of vascular invasion based on cross-sectional MRI or CT
Criteria for successful downstaging
	Residual tumor(s) within MC for deceased donor liver transplant
	In patients with 4 or 5 tumors, successful downstaging requires complete necrosis (based on cross-sectional MRI or CT) of at least 1 to 2 tumor(s), respectively, so that there will be no more than 3 lesions with viable tumor each ≤ 3 cm to meet MC
Criteria for downstaging failure and exclusion from liver transplant
	Progression of tumor(s) to beyond inclusion criteria for downstaging and bridging based on tumor size and number
	Vascular invasion based on cross-sectional MRI or CT
	Lymph node involvement by tumor or extra-hepatic spread of tumor

MC: Milan criteria; UNOS: United Network for Organs Sharing; HCC: Hepatocellular carcinoma; MRI: Magnetic resonance imaging; CT: Computed tomography.