Milan criteria

The Milan criteria select patients with hepatocellular carcinoma for liver transplant with outcomes similar to those without cancer. Measure tumours on the most recent CT or MRI, counting only viable (enhancing) tumour after locoregional treatment.

Copy result for a letterClear

Criteria

• Milan: a single tumour up to 5 cm, or up to 3 tumours each up to 3 cm; no macrovascular invasion or extrahepatic spread.
• UCSF: a single tumour up to 6.5 cm, or up to 3 tumours with the largest up to 4.5 cm and a total diameter up to 8 cm.
• Up-to-seven: the diameter of the largest tumour (cm) plus the number of tumours is 7 or less, with no microvascular invasion on the explant.
• The AFP and response to downstaging also matter; see Metroticket 2.0. Australian and New Zealand units apply their own expanded criteria.

References

Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693-699.

Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394-1403.

Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10(1):35-43.