Tissue biomarkers as predictors of outcome and selection of transplant candidates with hepatocellular carcinoma

✍ Scribed by Josep M. Llovet; Valerie Paradis; Masatoshi Kudo; Jessica Zucman-Rossi

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 90 KB
• Volume: 17
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22340

✦ Synopsis

Hepatocellular carcinoma (HCC) is a common cause of cancer deaths worldwide, and its annual incidence is rising. Liver transplantation (LT) is an accepted curative treatment for patients with tumors satisfying the Milan criteria (a single tumor 5 cm in diameter or up to 3 tumors with individual diameters 3 cm and no macrovascular invasion). These criteria predict an overall 5-year survival rate of 70% after LT. 1 Since the introduction of the Milan criteria, subsequent studies have explored the expansion of transplant recipient selection to include individuals with tumors exceeding the Milan criteria. 2 A recent study demonstrated an acceptable overall 5-year survival rate (71.2%) for patients who underwent transplantation for tumors that were beyond the Milan criteria but satisfied the up-to-7 rule (7 is the sum of the size of the largest tumor in centimeters and the number of tumors) in the absence of microvascular invasion. This approach is based on the best data available for understanding tumor behavior after LT, but it is still based on pathological data. The tumor size and the tumor number cannot be used to define subclasses of patients with better biology and better outcomes, so biomarkers are expected to be a major step forward in this setting during the next decade.

Numerous molecular pathways involved in the pathogenesis of HCC have been identified. These include activation pathways that are involved in angiogenesis [vascular endothelial growth factor (VEGF)], in cell proliferation and survival (epidermal growth factor, insulin-like growth factor, and hepatocyte growth factor/ Met), and in cell differentiation and proliferation (Wnt/ b-catenin and hedgehog signaling). The activation of