Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2016; 6(2): 411-422
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.411
Proposal of new expanded selection criteria using total tumor size and 18F-fluorodeoxyglucose - positron emission tomography/computed tomography for living donor liver transplantation in patients with hepatocellular carcinoma: The National Cancer Center Korea criteria
Seung Duk Lee, Bora Lee, Seong Hoon Kim, Jungnam Joo, Seok-Ki Kim, Young-Kyu Kim, Sang-Jae Park
Seung Duk Lee, Seong Hoon Kim, Sang-Jae Park, Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 10408, South Korea
Bora Lee, Jungnam Joo, Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang 10408, South Korea
Seok-Ki Kim, Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Goyang 10408, South Korea
Young-Kyu Kim, Department of Surgery, College of Medicine, Jeju National University, Jeju-do 63241, South Korea
Author contributions: Lee SD designed study and wrote the paper; Lee B and Joo J performed the statistical analysis; Kim SH designed the study and performed research; Kim SK, Kim YK and Park SJ performed the study.
Institutional review board statement: This study was reviewed and approved by the National Cancer Center Institutional Review Board.
Informed consent statement: This is the retrospective study and we analyzed data using only medical records. Therefore, waiver of informed consent for this study subjects might be justifiable. In our institute IRB, waiver of informed consent in this study was approved.
Conflict-of-interest statement: The authors declare no potential conflicts of interest and funding resources.
Data sharing statement: Technical appendix, statistical code, and dataset available from the first author at 1sd@ncc.re.kr. Participent's consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seong Hoon Kim, MD, PhD, Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, Goyang 10408, South Korea. kshlj@ncc.re.kr
Telephone: +82-31-9201647 Fax: +82-31-9202799
Received: December 22, 2015
Peer-review started: December 23, 2015
First decision: January 15, 2016
Revised: January 18, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: June 24, 2016
Processing time: 183 Days and 7.8 Hours
Abstract

AIM: To expand the living donor liver transplantation (LT) pool of eligible patients with hepatocellular carcinoma (HCC) using new morphological and biological criteria.

METHODS: Patients with HCC who underwent living donor LT (LDLT) from March 2005 to May 2013 at the National Cancer Center Korea (NCCK) were enrolled. We performed the 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) before LDLT. Overall and disease-free survival analysis was done in patients to evaluate the usefulness of new NCCK criteria using PET/CT and total tumor size (10 cm).

RESULTS: We enrolled a total of 280 patients who pathologically confirmed to have HCC and performed the PET/CT before transplantation. Among them, 164 (58.6%) patients fulfilled the NCCK criteria and 132 patients (47.1%) met the Milan criteria. Five-year overall and disease-free survival rates for patients who fulfilled the NCCK criteria showed 85.2% and 84.0%, respectively, and were significantly higher than those beyond the NCCK criteria (60.2% and 44.4%, respectively; P < 0.001). The correlation analysis between preoperative imaging tests and pathologic reports using Cohen’s Kappa demonstrated the better results in the NCCK criteria than those in the Milan criteria (0.850 vs 0.583). The comparison of disease-free analysis among the NCCK, Milan, and University of California, San Francisco (UCSF) criteria using the receiver operating characteristics curves revealed the similar area under the curve value criteria (NCCK vs Milan, P = 0.484; NCCK vs UCSF, P = 0.189 at 5-years).

CONCLUSION: The NCCK criteria using hybrid concept of both morphological and biological parameters showed an excellent agreement between preoperative imaging and pathological results, and favorable survival outcomes. These new criteria might select the optimal patients with HCC waiting LDLT and expand the selection pool.

Keywords: Hepatocellular carcinoma; Living donor; Liver transplantation; Selection criteria

Core tip: National Cancer Center Korea criteria using positron-emission tomography/computed tomography positivity and total tumor size (cutoff 10 cm) expanded the pool of living donor liver transplantation for patients with hepatocellular carcinoma. Patient identification on the bases of the criteria showed an excellent agreement between preoperative imaging and pathological results and favorable survival outcomes.