Since freedom from recurrence was not significantly different in patients who met versus patients who exceeded the Milan criteria, the authors conclude that these criteria may not be crucial in predicting recurrence. "Our study suggests that oncological control reached by the scheduled TACE pretreatment during the waiting time is obviously of greater importance for the long-term prognosis than downstaging [reducing tumor size] itself," the author state. "According to our data, favorable tumors seem to be selected with a much higher degree of reliability if the process of tumor control persists during the total waiting time." They maintain that even large or multiple tumors can be successfully treated by liver transplant if they show a favorable response and remain stable during pretreatment with TACE. "This observation may form a basis of biologically more plausible selection criteria rather than simple tumor size or tumor number," they conclude.

In an accompanying editorial in the same issue, Francis Y. Yao, M.D. of the Division of Gastroenterology at the University of California, San Francisco acknowledges that "this article raises the intriguing possibility of looking beyond tumor size and number in selecting patients with HCC for OLT [liver transplant], but without relying on information that requires biopsy of the tumor." He adds that since no upper limits in tumor size and number were used to exclude patients from receiving transplants, one might conclude that all patients would be eligible for a transplant regardless of tumor size as long they responded to a local treatment such as TACE. However, other research contradicts this conclusion and it is likely that an upper limit in tumor size and number exists beyond which a transplant will most likely yield poor results, despite pre
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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
1-Aug-2006