Evidence map›Paper›PMID 27178646›Full record

ArticleHepatology (Baltimore, Md.)2016

The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: A prospective validation study.

Gonzalo Sapisochin, Nicolas Goldaracena, Jerome M Laurence, Martin Dib, Andrew Barbas, Anand Ghanekar, Sean P Cleary, Les Lilly, Mark S Cattral, Max Marquez and 6 more

Registry-linked trialAbstract readValidation Study
PubMed Publisher
In one paragraph

Article in Hepatology (Baltimore, Md.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05185505 (Atezolizumab and Bevacizumab Pre-Liver Transplantation for Patients With Hepatocellular Carcinoma Beyond Milan Criteria), which is not on this map. Cited by 159 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
159citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05185505 phase4recruitingnot on this mapstarted 2023, after this paper: background citation

Atezolizumab and Bevacizumab Pre-Liver Transplantation for Patients With Hepatocellular Carcinoma Beyond Milan Criteria: A Feasibility Study

TypeinterventionalSponsorThe Methodist Hospital Research InstituteRan2023 to 2027Enrolled24ConditionsHepatocellular Carcinoma, Hepatocellular CancerArmsAtezolizumab, Bevacizumab
3 · Its place in the literature

Who cites it

159 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  10. Improving surgical treatments for hepatocellular carcinoma.Nature reviews. Gastroenterology & hepatology · 2026
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99 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors.

Gonzalo SapisochinDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Nicolas GoldaracenaDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Jerome M LaurenceDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Martin DibDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Andrew BarbasDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Anand GhanekarDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Sean P ClearyDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Les LillyMulti-Organ Transplant, Toronto General Hospital, University of Toronto, Toronto, Canada.
Mark S CattralDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Max MarquezMulti-Organ Transplant, Toronto General Hospital, University of Toronto, Toronto, Canada.
Markus SelznerDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Eberhard RennerMulti-Organ Transplant, Toronto General Hospital, University of Toronto, Toronto, Canada.
Nazia SelznerMulti-Organ Transplant, Toronto General Hospital, University of Toronto, Toronto, Canada.
Ian D McGilvrayDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Paul D GreigDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
David R GrantDepartment of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The selection of liver transplant candidates with hepatocellular carcinoma (HCC) relies mostly on tumor size and number. Instead of relying on these factors, we used poor tumor differentiation and cancer-related symptoms to exclude patients likely to have advanced HCC with aggressive biology. We initially reported similar 5-year survival for patients whose tumors exceeded (M+ group) and were within (M group) the Milan criteria. Herein, we validate our original data with a new prospective cohort and report the long-term follow-up (10-years) using an intention-to-treat analysis. The previously published study (cohort 1) included 362 listed (294 transplanted) patients from January 1996 to August 2008. The validation cohort (cohort 2) includes 243 listed (105 M+ group, 76 beyond University of California San Francisco criteria; 210 transplanted) patients from September 2008 to December 2012. Median follow-up from listing was 59.7 (26.8-103) months. For the validation cohort 2, the actuarial survival from transplant for the M+ group was similar to that of the M group at 1 year, 3 years, and 5 years: 94%, 76%, and 69% versus 95%, 82%, and 78% (P = 0.3). For the combined cohorts 1 and 2, there were no significant differences in the 10-year actuarial survival from transplant between groups. On an intention-to-treat basis, the dropout rate was higher in the M+ group and the 5-year and 10-year survival rates from listing were decreased in the M+ group. An alpha-fetoprotein level >500 ng/mL predicted poorer outcomes for both the M and M+ groups.

conclusionTumor differentiation and cancer-related symptoms of HCC can be used to select patients with advanced HCC who are appropriate candidates for liver transplantation; alpha-fetoprotein level limitations should be incorporated in the listing criteria for patients within or beyond the Milan criteria. (Hepatology 2016;64:2077-2088).

Indexed as

Liver TransplantationPatient SelectionCarcinoma, HepatocellularFemaleFollow-Up StudiesHumansLiver NeoplasmsMaleMiddle AgedProspective Studies

Identifiers

PMID27178646

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.