Metroticket Calculator for Hepatocellular Carcinoma (HCC) Survival
- Derived in order to explore whether certain patients not fulfilling Milan Criteria could potentially benefit from liver transplant.
- Similar survival as Milan criteria if criteria are expanded to Up-to-Seven(size of largest tumor in cm + number of tumors ≥7).
- Not as widely used or validated as the original Milan criteria.
- Tumor grade was not included as a prognostic factor, though it is known to correlate with survival. The authors cited a high number of patients missing data on tumor grade (28.5%) and used vascular invasion as an alternate pathologic parameter.
- Patients with HCC not fulfilling Milan Criteria but who may be considered for transplant with similar benefit.
- Allows patients who don't fit the original Milan Criteria to be considered for transplantation with similar predicted survival benefit.
- Offers potential curative option for patients who don't meet the Milan criteria.
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Complex matrix of values based on number of nodules and diameter of nodules.
Facts & Figures
For more information on the Metroticket calculators, visit the Metroticket Project website.
- The Metroticket calculator was derived by Mazzaferro and colleagues (who also developed the Milan criteria) in 2009 in order to more accurately characterize survival of patients failing to fulfill the Milan criteria.
- Data from 1,556 patients at 36 centers were collected, 1,112 of whom exceeded (did not meet) the Milan criteria. Multivariable Cox regression models were used, with TNM staging specifications, to estimate survival based on the criteria, and an expanded version of the Milan criteria termed the Up-to-Seven criteria (size of largest tumor in cm + number of tumors ≥7) identified patients who did not meet the original Milan criteria but still had similar 5-year survival: 71.2% (95% CI 64.3-77.0) versus 73.3% (95% CI 68.2-77.7).
- The data were collected via a web-based survey that could be filled out at the discretion of the investigators, thus potentially introducing bias.
- The results have been validated in other populations including Chinese patients (Lei 2013) and patients undergoing transplant for Hepatitis B (Raj 2011).
Original/Primary ReferenceMazzaferro V, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009 Jan;10(1):35-43. doi: 10.1016/S1470-2045(08)70284-5. Epub 2008 Dec 4.
ValidationLei J-Y, Wang W-T, Yan L-N. “Metroticket” predictor for assessing liver transplantation to treat hepatocellular carcinoma: A single-center analysis in mainland China. World Journal of Gastroenterology : WJG. 2013;19(44):8093-8098. doi:10.3748/wjg.v19.i44.8093.Raj A, McCall J, Gane E. Validation of the “Metroticket” predictor in a cohort of patients transplanted for predominantly HBV-related hepatocellular carcinoma. J Hepatol. 2011 Nov;55(5):1063-8. doi: 10.1016/j.jhep.2011.01.052. Epub 2011 Feb 25.
About the Creator
Vincenzo Mazzaferro, MD, is a professor of medicine and director of the Gastrointestinal and Hepato-Pancreatic Surgery and Liver Transplantation Unit at the Istituto Nazionale dei Tumori in Milan, Italy. He is an avid researcher of liver transplantation and studies treatment of metastatic cancers to the liver and novel treatments of tumors. Dr. Mazzaferro’s research group was responsible for the development of the Milan Criteria, which has been adopted as a transplant guideline in many countries.
To view Dr. Vincenzo Mazzaferro's publications, visit PubMed