Up to 75 percent of patients with advanced hepatocellular carcinoma (HCC), the most common liver cancer, are still alive five years after liver transplants under an innovative treatment led by a Chinese research team. The survival rate is more than 25 percent of the national level, under regular treatment.

The man behind the breakthrough is Fan Jia, deputy president of Zhongshan Hospital Affiliated to Fudan University in Shanghai, who has spent 12 years on research with his team.

They have made a series of remarkable advances.

One of them is giving more HCC patients a chance to undergo liver transplants.

The Milan criteria, a common international practice, limits liver transplant surgery to those with one lesion of not more than 5 cm in diameter or not more than three lesions, each not exceeding 3 cm. Under such criteria, the survival rate after transplant surgery can reach up to 70 percent after five years.

"But this criteria is too strict and many patients who could benefit from a liver transplant may be unnecessarily excluded," Fan says.

Fan and his team expanded the Milan criteria and obtained similar survival rate. Named the Shanghai Fudan criteria, patients can undergo a liver transplant as long as they have a single tumor not larger than 9 cm in diameter or not more than three tumors, each not exceeding 5 cm and total diameter not more than 9 cm.

Before surgery, patients undergo tumor cell biological characteristics analysis to ensure they receive the optimum therapeutic solution, which will limit the use of liver resources and improve the effect of the liver transplant.

Liver cancers are malignant tumors that grow on the surface or inside the liver. Generally, there are two types of liver cancers: primary and metastatic. The latter is actually metastases from other tumors, such as colon cancer, breast cancer and lung cancer. HCC accounts for about 70 percent of all liver cancers.

China has the highest number of liver cancer patients worldwide. Each year, there are approximately 400,000 cases of liver cancer in China, which accounts for 55 percent of new cases worldwide. About 300,000 people die of the disease each year in the country.

In China, the most common cause for liver cancer is chronic infection with hepatitis B virus (HBV).

Liver transplant offers a higher rate of survival, but is also limited by many challenges, such as the absence of preventive and therapeutic strategies to reduce the recurrence of HCC. About 26.5 percent of HCC patients suffer recurrence five years after transplant surgery.

"To lower the recurrence after surgery is the key point and also the most difficult," Fan says.

It is quite common for patients to have serious rejection reactions after surgery. To minimize rejection, doctors have to seek measures, such as using drugs to artificially suppress patients' immune system. But, such drugs also lower the body's resistance to cancer cells.

Fan and his team found a particular cell with a high rate of recurrence.

"Our study revealed that Capn4 is an important molecule associated with HCC metastasis and recurrence. And it's a candidate biomarker for future diagnosis and a target for therapy," he says.

The discovery will help doctors carry out early prevention, such as using targeted drugs and chemotherapy.

Many hospitals in China have benefited from the findings.

"The new strategy has saved many lives, and it has wide social benefit," says Zhu Zhijun, a doctor from Tianjin No 1 Center Hospital.

"This innovative treatment is highly practical and has achieved satisfying effects," says Peng Zhihai, a doctor from Shanghai No 1 People's Hospital.

Earlier this year, Fan and his team received Shanghai municipality's highest prize on science and technology.

wanghongyi@chinadaily.com.cn