Aim:Eligibility for liver transplantation for hepatocellular carcinoma(HCC)is currently based on singledimension,diameter measurements on cross-sectional imaging,as specified by various selection criteria.This does no...Aim:Eligibility for liver transplantation for hepatocellular carcinoma(HCC)is currently based on singledimension,diameter measurements on cross-sectional imaging,as specified by various selection criteria.This does not account for significant differences in shape,and therefore tumour volume,between patients.This study investigated whether one-dimensional selection criteria disadvantages patients by not considering volume.Methods:Patient data were collected retrospectively from a prospectively maintained database.Tumours were measured on both computer tomography(CT)and magnetic resonance imaging(MRI).Tumour volume was measured using two methods;semi-automated planimetry and the ellipsoid volume formula.Statistical analysis was performed using SPSS.Results:A total of 313 patients with HCC were assessed for liver transplantation.For this study,patients who underwent transplantation(n=89)and those who did not based on tumour size(n=33)were included.In total,213 tumours were measured,showing excellent correlation between CT and MRI(R^(2)=0.83).The majority of tumour nodules(94%)were ellipsoid not spherical.Volumetric measurements of the 84 tumours that did not meet diameter-based Milan criteria confirmed that 76%would have been within a theoretical volume allowance based on Milan criteria diameters.Conclusion:This study shows that a significant number of patients deemed outside conventional diameter-based Milan criteria have smaller tumour volumes than those considered within criteria.It appears that those with ellipsoid rather than spherical tumours may be disadvantaged by current size-based criteria.Further research using a contemporary patient cohort who have had the benefit of advancements in non-surgical treatments for HCC is required.展开更多
文摘Aim:Eligibility for liver transplantation for hepatocellular carcinoma(HCC)is currently based on singledimension,diameter measurements on cross-sectional imaging,as specified by various selection criteria.This does not account for significant differences in shape,and therefore tumour volume,between patients.This study investigated whether one-dimensional selection criteria disadvantages patients by not considering volume.Methods:Patient data were collected retrospectively from a prospectively maintained database.Tumours were measured on both computer tomography(CT)and magnetic resonance imaging(MRI).Tumour volume was measured using two methods;semi-automated planimetry and the ellipsoid volume formula.Statistical analysis was performed using SPSS.Results:A total of 313 patients with HCC were assessed for liver transplantation.For this study,patients who underwent transplantation(n=89)and those who did not based on tumour size(n=33)were included.In total,213 tumours were measured,showing excellent correlation between CT and MRI(R^(2)=0.83).The majority of tumour nodules(94%)were ellipsoid not spherical.Volumetric measurements of the 84 tumours that did not meet diameter-based Milan criteria confirmed that 76%would have been within a theoretical volume allowance based on Milan criteria diameters.Conclusion:This study shows that a significant number of patients deemed outside conventional diameter-based Milan criteria have smaller tumour volumes than those considered within criteria.It appears that those with ellipsoid rather than spherical tumours may be disadvantaged by current size-based criteria.Further research using a contemporary patient cohort who have had the benefit of advancements in non-surgical treatments for HCC is required.
