Toniutto Pierluigi, Fumolo Elisa, Fornasiere Ezio, Bitetto Davide
Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy.
J Clin Med. 2021 Aug 31;10(17):3932. doi: 10.3390/jcm10173932.
The Milan criteria (MC) were developed more than 20 years ago and are still considered the benchmark for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). However, the strict application of MC might exclude some patients who may receive a clinical benefit of LT. Several expanded criteria have been proposed. Some of these consider pretransplant morphological and biological variables of the tumor, others consider post-LT variables such as the histology of the tumor, and others combine pre- and post-LT variables. More recently, the HCC response to locoregional treatments before transplantation emerged as a surrogate marker of the biological aggressiveness of the tumor to be used as a better selection criterion for LT in patients beyond the MC at presentation. This essential review aims to present the current data on the pretransplant selection criteria for LT in patients with HCC exceeding the MC at presentation based on morphological and histological characteristics of the tumor and to critically discuss those that have been validated in clinical practice. Moreover, the role of HCC biological markers and the tumor response to downstaging procedures as new tools for selecting patients with a tumor burden outside of the MC for LT is evaluated.
米兰标准（MC）于20多年前制定，至今仍是肝细胞癌（HCC）患者肝移植（LT）的基准。然而，严格应用MC可能会排除一些可能从LT中获得临床益处的患者。已经提出了几种扩展标准。其中一些考虑肿瘤的移植前形态学和生物学变量，另一些考虑LT后变量，如肿瘤组织学，还有一些结合了LT前后变量。最近，移植前局部区域治疗对HCC的反应成为肿瘤生物学侵袭性的替代标志物，可作为目前超出MC的患者LT更好的选择标准。本重要综述旨在基于肿瘤的形态学和组织学特征，介绍目前关于超出MC的HCC患者LT移植前选择标准的数据，并批判性地讨论那些已在临床实践中得到验证的标准。此外，还评估了HCC生物标志物的作用以及肿瘤对降期程序的反应作为选择肿瘤负荷超出MC的患者进行LT的新工具的作用。
