Milan criteria are useful predictors for favorable outcomes in hepatocellular carcinoma patients undergoing liver transplantation after transarterial chemoembolization

Table 1 Baseline clinical, demographic, and imaging-based tumor characteristics of the enrolled patients (mean ± SD)

Characteristics	TACE + LT group (n = 36)	LT group (n = 21)	P
Age (yr)	49 ± 8.2	52 ± 8.0	0.13
Sex (M/F)	31/5	18/3	0.99
Etiology of liver disease			0.12
HBV	34 (94.4%)	18 (85.7%)
HCV	0 (0%)	2 (9.5%)
HBV + HCV	1 (2.8%)	0 (0%)
Alcoholic	0 (0%)	1 (4.8%)
α-fetoprotein (µg/L)	193 ± 472	1012 ± 4110	0.24
TACE
1	12 (33.3%)	-
2	16 (44.4%)	-
≥ 3	8 (22.2%)	-
MELD score	19 ± 9	22 ± 9	0.10
Type of graft
Cadaveric graft	8 (22.2%)	2 (9.5%)	0.30
Living graft	28 (77.8%)	19 (90.5%)
Number of nodules
1/2/3	24/6/6	18/2/1	0.26
Diameter of the largest tumor (cm)			0.10
Mean ± SD	2.0 ± 0.6	2.3 ± 0.9
Range	0.9-4.0	1.0-4.0
Sum of the tumor diameters (cm)			0.38
Mean ± SD	2.5 ± 1.1	2.8 ± 1.3
Range (cm)	0.9-6.1	1.0-5.9

TACE: Transarterial chemoembolization; LT: Liver transplantation; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MELD: Model for end stage liver disease.

Table 2 Histologic finding-based tumor profiles of patients who met the Milan criteria

Variable	TACE + LT group (n = 36)	LT group (n = 21)	P
Number of nodules
1/2/3/≥4	18/8/3/7	13/3/3/2	0.79
Diameter of the largest tumor (cm)
Mean ± SD	2.5 ± 1.4	2.3 ± 0.9	0.70
Range	0.6-7.5	0.5-4.2
Sum of the tumor diameters (cm)
Mean ± SD	3.8 ± 2.6	3.3 ± 1.3	0.36
Range	0.6-14.0	0.5-7.0
Tumor differentiation1			0.59
Edmonson gradeI	5 (16.7%)	6 (28.6%)
II	22 (73.3%)	13 (61.9%)
III	3 (10%)	2 (9.5%)
Presence of satellite nodule	5 (13.9%)	2 (9.5%)	0.99
Tumor capsule invasion	11 (30.6%)	3 (14.3%)	0.21
Microvascular invasion	11 (30.6%)	9 (42.9%)	0.40

¹Assessment of tumor differentiation was possible in only 30 patients in TACE + LT group due to complete necrosis in 6 patients. TACE: Transarterial chemoembolization; LT: liver transplantation.

Table 3 Detailed clinical data of the patients in whom HCC recurred after LT

Patient	Group	Time to recur (mo)	Site of recur	Treatment after recurrence	Survival (mo)
1	TACE + LT	9.6	Liver	None	10.0
2	TACE + LT	3.3	Liver, bone	TACE	7.1
3	LT	15.4	Lymph node	Excision, TACE	21.0
4	TACE + LT	0.9	Lung, liver	TACE	5.7

TACE: Transarterial chemoembolization; LT: Liver transplantation.