SynthesisAsian Pacific journal of cancer prevention : APJCP2025
Prognostic Significance of Up-to-Seven Criteria Versus Milan Criteria for Hepatocellular Carcinoma Patients Undergoing Resection or Locoregional Therapy: A Systematic Review and Meta-Analysis.
Synthesis in Asian Pacific journal of cancer prevention : APJCP, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionEvery year, the incidence of hepatocellular carcinoma (HCC) rises, making it a persistent global health concern. To help patients with HCC make treatment options for transplant eligibility, a number of selection criteria, including the Milan and Up-to-Seven criteria, have been developed; however, it is unclear how well these predict outcomes. This study aimed to evaluate the prognostic significance of Up-to-Seven versus Milan criteria in HCC patients undergoing resection or locoregional therapy.
methodsIn accordance with PRISMA criteria, a systematic review and meta-analysis were performed. The Cochrane Library, PubMed, ScienceDirect, Google Scholar, SpringerLink, and Ebsco were searched for relevant literature. Included were studies contrasting prognostic outcomes (disease-free survival [DFS], progression-free survival [PFS], and overall survival [OS]) according to the two criteria. Review Manager 5.4 was used for data analysis.
resultsFive retrospective cohort studies involving 921 patients were analyzed. The meta-analysis revealed a significant difference in OS (HR = 3.42; 95% CI: 2.23-5.25; p < 0.00001) and PFS (HR = 3.39; 95% CI: 1.09-10.54; p = 0.04), favoring the Milan criteria. No significant difference was found in DFS (HR = 2.42; 95% CI: 0.95-6.14; p = 0.06).
conclusionThe Up-to-Seven criteria demonstrated non-inferior prognostic performance to the Milan criteria for DFS, while Milan criteria were associated with significantly better OS and PFS. These findings suggest that the Up-to-Seven criteria may serve as an acceptable alternative in broader patient selection for HCC therapy.
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