In summary, an available single marker of measuring the risk of tumor recurrence is still far away. Tumor biology has to be assessed by tumor burden, AFP levels, and response to therapy, including the use of PET and/or tumor biopsy in selected cases. https://t.co/uvZiAZS53E 10/10 https://t.co/nqPeQbM4EW

It has been postulated that poorly differentiated tumors can be identified by means of PET positivity, confirming that morphometric criteria alone might not be ideal discriminators in MC-out patients. https://t.co/uvZiAZS53E 9/10

AFP might help to identify patients with a high drop-out risk during downstaging, and on the other hand, an initial AFP <20 ng/ml might be predictive of a good response to downstaging therapies and a low recurrence rate after #LiverTransplant. https://t.co/uvZiAZS53E 8/10 https://t.co/SZfzjbM78i

Patients within the MC might not need a tumor biopsy, due to the relatively low risk of G3 tumors, and the acceptable risk of mVI. However, in these patients, the very low risk has to be weighed against the potential benefit of tumor biopsy https://t.co/uvZiAZS53E 7/10 https://t.co/OcvAsfrrdb

The justification for #downstaging and an acceptable drop-out rate needs to be seen and determined in light of the efficacy of alternative treatments, organ availability, and a patient’s attitude toward a concept holding a limited chance of success. https://t.co/uvZiAZS53E 6/10 https://t.co/YizOAz5lH1

While MC selection criteria were intended from an ITT perspective, they are too unspecific as a surrogate for tumor biology, withholding a life-saving procedure from a group of patients with large/multilocular, but biologically favorable HCCs https://t.co/uvZiAZS53E 5/10 https://t.co/xqtraowPCD

This results in different grades of differentiation, even within the same lesion, highlighting a critical unmet need for reliable invasive or non-invasive #preoperative #detection of microvascular invasion and/or tumor biology. https://t.co/uvZiAZS53E 4/10 https://t.co/Sm8kCcyV4w

Based on transcriptomic profiling, HCC subclassification interlinks dysregulation of signaling pathways with genetic alterations, histological subtypes, and prognosis, underlying the molecular heterogeneity of HCC. https://t.co/uvZiAZS53E 3/10

With advances in the understanding of #HCC biology, #Milan #criteria appear too restrictive, since a significant proportion of MC-out patients are curable undergoing #LiverTransplant https://t.co/uvZiAZSCTc 2/10