ArticleGastroenterology2021
Downstaging Outcomes for Hepatocellular Carcinoma: Results From the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) Consortium.
Article in Gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 5 of them syntheses that pooled it.
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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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
62 citing papers in PubMed, 5 syntheses or guidelines pooled it, 140 citations in OpenAlex.
- Efficacy of Transarterial Radioembolization and Transarterial Chemoembolization as Downstaging or Bridging Strategies for Hepatocellular Carcinoma Before Liver Transplantation: A Systematic Review and Meta-Analysis.Cardiovascular and interventional radiology · 2026Pooled it
- Taiwan liver cancer association management consensus guidelines for intermediate-stage hepatocellular carcinoma.Clinical and molecular hepatology · 2025Guideline
- Racial and Ethnic Disparities in Hepatocellular Carcinoma Treatment Receipt in the United States: A Systematic Review and Meta-Analysis.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2024Pooled it
- Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation.Hepatology international · 2024Guideline
- 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma.Clinical and molecular hepatology · 2022Guideline
- Immune-checkpoint inhibitors for advanced hepatocellular carcinoma in Child-Turcotte-Pugh-B cirrhosis: a liver-centric approach to outcomes beyond tumor progression.Hepatology international · 2026Review
- Radiation segmentectomy for hepatocellular carcinoma: redefining the limits of curative-intent therapy.The British journal of radiology · 2026Review
- Hepatocellular Carcinoma Bridging and Downstaging: Advances in Locoregional Therapy.Biomedicines · 2026Review
- Post-transplant hepatocellular carcinoma: balancing immunosuppression and immune checkpoint inhibitors.Clinical and molecular hepatology · 2026Review
- Liver transplantation for hepatocellular carcinoma: from patient selection and downstaging to risk stratification and post-transplant surveillance.Gastroenterology report · 2026Review
- The role of immunotherapy prior to liver transplantation in advanced or down-staged HCC - timing of transplants, selection of patients, and hurdles to overcome with immunosuppression.International journal of surgery (London, England) · 2026Review
- China Liver Cancer Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2024 Edition).Liver cancer · 2025Article
- Survival impact of conversion therapy for Barcelona Clinic Liver Cancer (BCLC) stage B and C hepatocellular carcinoma-a propensity score matching analysis.Hepatobiliary surgery and nutrition · 2025Article
- Management of hepatocellular carcinoma prior to liver transplantation: latest developments.Hepatic oncology · 2025Review
- [Novel research horizon for liver transplantation management model in hepatocellular carcinoma based on the tumor-donor liver-recipient].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Article
- Transforming Liver Cancer Therapy: Integrating Molecular Profiling with Precision and Transplant-Based Care.Cancers · 2025Review
- Resection and yttrium-90 radioembolization as sequential downstaging to living donor liver transplantation for large, multifocal hepatocellular carcinoma with lobar portal vein tumor thrombosis.Hepatobiliary surgery and nutrition · 2025Article
- Review Article: Liver Transplantation for Hepatocellular Carcinoma in the Era of Immune Checkpoint Inhibitors.Alimentary pharmacology & therapeutics · 2025Review
- SBRT for bridging and downstaging HCC before transplant.JHEP reports : innovation in hepatology · 2025Article
- Emerging Trends in Neoadjuvant Immunotherapy for Hepatocellular Carcinoma: A Focus on Liver Transplant Candidates.Cancer reports (Hoboken, N.J.) · 2025Review
2 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 7 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsUnited Network of Organ Sharing (UNOS) has adopted uniform criteria for downstaging (UNOS-DS) of hepatocellular carcinoma (HCC) before liver transplantation (LT), but the downstaging success rate and intention-to-treat outcomes across broad geographic regions are unknown.
methodsIn this first multiregional study (7 centers, 4 UNOS regions), 209 consecutive patients with HCC undergoing downstaging based on UNOS-DS criteria were prospectively evaluated from 2016 to 2019.
resultsProbability of successful downstaging to Milan criteria and dropout at 2 years from the initial downstaging procedure was 87.7% and 37.3%, respectively. Pretreatment with lectin-reactive α-fetoprotein ≥10% (hazard ratio, 3.7; P = .02) was associated with increased dropout risk. When chemoembolization (n = 132) and yttrium-90 radioembolization (n = 62) were compared as the initial downstaging treatment, there were no differences in Modified Response Evaluation Criteria In Solid Tumors response, probability of or time to successful downstaging, waiting list dropout, or LT. Probability of LT at 3 years was 46.6% after a median of 17.2 months. In the explant, 17.5% had vascular invasion, and 42.8% exceeded Milan criteria (understaging). The only factor associated with understaging was the sum of the number of lesions plus largest tumor diameter on the last pre-LT imaging, and the odds of understaging increased by 35% per 1-unit increase in this sum. Post-LT survival at 2 years was 95%, and HCC recurrence occurred in 7.9%.
conclusionIn this first prospective multiregional study based on UNOS-DS criteria, we observed a successful downstaging rate of >80% and similar efficacy of chemoembolization and yttrium-90 radioembolization as the initial downstaging treatment. A high rate of tumor understaging was observed despite excellent 2-year post-LT survival of 95%. Additional LRT to reduce viable tumor burden may reduce tumor understaging.
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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.