# Up-to-seven HCC transplant criteria

Up-to-seven

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/up_to_7`
HTML: https://magentlab.com/docs/up-to-7
Markdown: https://magentlab.com/docs/up-to-7.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply Mazzaferro 2009 Up-to-seven criteria and return whether tumor_count plus largest_cm is 7 or less without microvascular invasion (meets_up_to_seven).

## When to use

When an agent already has tumor count, largest diameter in centimetres, and a microvascular-invasion flag as in Mazzaferro 2009, and needs the published Up-to-seven eligibility result. magent does not interpret imaging or histology.

## When not to use

- Not a medical device.
- Not a transplant listing or organ-allocation order.
- Pathology/explant-style inputs as assigned by the caller. magent does not interpret imaging or histology.
- This tool is Mazzaferro 2009 Up-to-seven criteria only. Not Milan criteria and not Metroticket 2.0 AFP-adjusted-to-HCC-size criteria.
- Not a website contour calculator.
- Does not output a survival percentage. The paper's 71.2% 5-year overall survival subgroup was patients without microvascular invasion who fell within up-to-seven; this tool returns the boolean criteria result only.

## Formula

```
meets_up_to_seven iff size_number_sum <= 7 and not microvascular_invasion; size_number_sum = tumor_count + largest_cm (Mazzaferro 2009 Up-to-seven)
```

## Citation

[Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis](https://doi.org/10.1016/S1470-2045(08)70284-5)
Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, Camerini T, Roayaie S, Schwartz ME, Gonzalez FJ, et al.
Lancet Oncol. 2009;10(1):35-43
DOI: [10.1016/S1470-2045(08)70284-5](https://doi.org/10.1016/S1470-2045(08)70284-5)

## Worked example

### Three tumors, largest 4 cm, no microvascular invasion

Given: `largest_cm=4, microvascular_invasion=false, tumor_count=3`

1. tumor_count 3 plus largest_cm 4.0 is size_number_sum 7
2. size_number_sum 7 is <= 7 and microvascular_invasion is false
3. meets_up_to_seven is true


## Also searched as

- Up-to-seven
- Up-to-7 criteria
- Mazzaferro 2009
- beyond Milan HCC
- HCC size plus number
- up to seven transplant
- hepatocellular carcinoma beyond Milan
- liver transplant HCC up-to-seven

## Parameters

- `tumor_count` (integer, required): Number of HCC nodules (integer 1-20) as assigned by the caller. Added to largest_cm as size_number_sum. The Up-to-seven ceiling is size_number_sum <= 7. magent does not interpret imaging or histology.
- `largest_cm` (number, required): Largest tumor diameter in centimetres (0.1-30) as assigned by the caller. Added to tumor_count as size_number_sum. Equality at 7.0 meets; 7.1 fails. magent does not interpret imaging or histology.
- `microvascular_invasion` (boolean, required): Microvascular invasion as assigned by the caller (pathology/explant-style). true fails Up-to-seven even when size_number_sum is 7 or less. true or false. magent does not interpret imaging or histology.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/up_to_7`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "largest_cm": "4",
      "microvascular_invasion": "false",
      "tumor_count": "3"
    },
    {
      "largest_cm": "4",
      "microvascular_invasion": "false",
      "tumor_count": "3"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/up-to-7

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/up_to_7",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, Camerini T, Roayaie S, Schwartz ME, Gonzalez FJ, et al.",
        "doi": "10.1016/S1470-2045(08)70284-5",
        "id": "mazzaferro-2009",
        "pmid": "19058754",
        "source": "Lancet Oncol. 2009;10(1):35-43",
        "title": "Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis"
      },
      "formula": "up_to_7",
      "formula_expression": "meets_up_to_seven iff size_number_sum <= 7 and not microvascular_invasion; size_number_sum = tumor_count + largest_cm (Mazzaferro 2009 Up-to-seven)",
      "criteria": [
        {
          "factor": "size_number_sum_le_7",
          "met": true
        },
        {
          "factor": "no_microvascular_invasion",
          "met": true
        }
      ],
      "largest_cm": 4.0,
      "tumor_count": 3,
      "size_number_sum": 7.0,
      "meets_up_to_seven": true,
      "microvascular_invasion": false
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, Camerini T, Roayaie S, Schwartz ME, Gonzalez FJ, et al.",
        "doi": "10.1016/S1470-2045(08)70284-5",
        "id": "mazzaferro-2009",
        "pmid": "19058754",
        "source": "Lancet Oncol. 2009;10(1):35-43",
        "title": "Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis"
      },
      "formula": "up_to_7",
      "formula_expression": "meets_up_to_seven iff size_number_sum <= 7 and not microvascular_invasion; size_number_sum = tumor_count + largest_cm (Mazzaferro 2009 Up-to-seven)",
      "criteria": [
        {
          "factor": "size_number_sum_le_7",
          "met": true
        },
        {
          "factor": "no_microvascular_invasion",
          "met": true
        }
      ],
      "largest_cm": 4.0,
      "tumor_count": 3,
      "size_number_sum": 7.0,
      "meets_up_to_seven": true,
      "microvascular_invasion": false
    }
  ]
}
```

## Response fields

- `formula` (string): up_to_7
- `formula_expression` (string): Mazzaferro 2009 Up-to-seven: size_number_sum <= 7 and no microvascular invasion
- `meets_up_to_seven` (boolean): true only when size_number_sum is 7 or less and microvascular_invasion is false. Not a transplant listing. Not a survival percentage.
- `size_number_sum` (number): tumor_count + largest_cm (nodule count plus largest diameter in cm)
- `tumor_count` (integer): Echo of the caller-assigned nodule count (1-20)
- `largest_cm` (number): Echo of the caller-assigned largest diameter in centimetres
- `microvascular_invasion` (boolean): Echo of the caller-assigned microvascular-invasion flag
- `criteria` (array): Per-factor Tree rows with factor and met; met is true when that Up-to-seven condition holds
- `citation` (object): Mazzaferro 2009 Lancet Oncol citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, Camerini T, Roayaie S, Schwartz ME, Gonzalez FJ, et al.",
    "doi": "10.1016/S1470-2045(08)70284-5",
    "id": "mazzaferro-2009",
    "pmid": "19058754",
    "source": "Lancet Oncol. 2009;10(1):35-43",
    "title": "Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis"
  },
  "formula": "up_to_7",
  "formula_expression": "meets_up_to_seven iff size_number_sum <= 7 and not microvascular_invasion; size_number_sum = tumor_count + largest_cm (Mazzaferro 2009 Up-to-seven)",
  "criteria": [
    {
      "factor": "size_number_sum_le_7",
      "met": true
    },
    {
      "factor": "no_microvascular_invasion",
      "met": true
    }
  ],
  "largest_cm": 4.0,
  "tumor_count": 3,
  "size_number_sum": 7.0,
  "meets_up_to_seven": true,
  "microvascular_invasion": false
}
```

## Errors

- HTTP 400 `invalid_tumor_count`: tumor_count must be an integer from 1 to 20 (Mazzaferro 1996). Returned before settlement; you are not charged.
- HTTP 400 `invalid_largest_cm`: largest_cm must be a number from 0.1 to 30 (Mazzaferro 1996). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Milan](https://magentlab.com/docs/milan) — Apply Mazzaferro 1996 Milan criteria and return whether the published size, count, vascular-invasion, and extrahepatic rules all hold (meets_milan).
- [Metroticket 2.0](https://magentlab.com/docs/metroticket-2) — Apply Mazzaferro 2018 Metroticket 2.0 AFP-adjusted-to-HCC-size criteria and return whether a published 70% 5-year HCC-specific survival band holds (meets_70pct_hcc_specific_survival).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.