A 50-year-old patient with end-stage liver disease (MELD score 28) secondary to hepatitis C cirrhosis is listed for liver transplantation. He has a 2 cm HCC on background cirrhosis. Regarding Milan criteria, which statement is correct?
- A Milan criteria: single HCC ≤ 3 cm or up to 2 nodules each ≤ 2 cm — 5-year survival ~85%
- B UCSF criteria (expanded Milan) are now the standard for all transplant centers
- C Milan criteria: single HCC ≤ 5 cm or up to 3 nodules each ≤ 3 cm, no vascular invasion, no extrahepatic spread — 5-year survival ~70% ✓
- D Any HCC in cirrhosis qualifies for transplant regardless of size if alpha-fetoprotein < 400 ng/mL
Explanation
The Milan criteria (Mazzaferro 1996) define the gold standard for liver transplantation in HCC: single lesion ≤ 5 cm or up to 3 lesions each ≤ 3 cm, with no macrovascular invasion and no extrahepatic disease. Patients meeting these criteria achieve 4-year overall survival rates of ~75–85%, comparable to transplantation for non-malignant disease. The UCSF criteria (single ≤ 6.5 cm or ≤ 3 nodules with largest ≤ 4.5 cm, total ≤ 8 cm) are more expanded but are used selectively; Milan remains the regulatory standard for UNOS listing. Alpha-fetoprotein alone is not a basis for listing.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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