The Milan Criteria for liver transplantation in hepatocellular carcinoma (HCC) define the eligibility boundaries. Which of the following patients meets expanded University of California San Francisco (UCSF) criteria but NOT Milan criteria, and is thus an appropriate candidate for expansion protocols?
- A Single HCC nodule of 3 cm, AFP 150 ng/mL, no vascular invasion
- B Single HCC nodule of 6.5 cm, no vascular invasion, AFP 500 ng/mL ✓
- C Three HCC nodules each 2 cm, no vascular invasion, AFP 40 ng/mL
- D Two nodules of 2.5 cm and 1.5 cm, no vascular invasion, AFP 60 ng/mL
Explanation
Milan criteria for liver transplant in HCC: single nodule ≤5 cm, or up to 3 nodules all ≤3 cm, no macrovascular invasion, no extrahepatic disease. UCSF criteria (Yao et al.) expand to: single nodule ≤6.5 cm, or up to 3 nodules with largest ≤4.5 cm and total tumor diameter ≤8 cm, no microvascular invasion on imaging. A 6.5 cm single nodule exceeds Milan (>5 cm) but meets UCSF criteria exactly. AFP scoring systems (AFP-French score, Metroticket 2.0) further refine selection within expanded criteria. Outcomes within UCSF criteria approach those within Milan criteria when strictly applied. Options A, C, and D all satisfy Milan criteria directly.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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