Belghiti Jacques
Department of Digestive Surgery and Transplantation, Hospital Beaujon, Clichy, France.
Semin Oncol. 2005 Dec;32(6 Suppl 8):29-32. doi: 10.1053/j.seminoncol.2005.07.023.
Currently, the primary use of liver transplantation in the setting of malignancy is in patients with hepatocellular carcinoma, with generally accepted criteria for transplantation consisting of the presence of one nodule less than 5 cm or two of three nodules each less than 3 cm in the absence of detectable vascular invasion. In some patients and settings, surgical resection before transplantation is an emerging, promising option. There is no clear beneficial role of transplantation in patients with resectable or unresectable cholangiocarcinoma, except in selected patients with unresectable disease that is associated with primary sclerosing cholangitis. While good survival results have been achieved with transplantation in patients with epithelioid hemangioendothelioma of the liver, the long-term survival of some patients without any radical treatment leaves the benefit of transplantation unclear. Transplantation would appear to benefit some patients with unresectable liver metastases from neuroendocrine tumors; those who present with non-neuroendocrine liver metastases are not considered candidates for transplantation.
目前，肝移植在恶性肿瘤领域的主要应用对象是肝细胞癌患者，普遍接受的移植标准包括：存在一个直径小于5厘米的结节，或三个结节中有两个直径均小于3厘米，且无可检测到的血管侵犯。在某些患者和情况下，移植前进行手术切除是一个新兴的、有前景的选择。除了少数与原发性硬化性胆管炎相关的不可切除疾病患者外，移植对于可切除或不可切除的胆管癌患者没有明确的有益作用。虽然肝上皮样血管内皮瘤患者通过移植取得了良好的生存结果，但一些未经任何根治性治疗的患者的长期生存情况使得移植的益处尚不清楚。移植似乎对一些患有不可切除的神经内分泌肿瘤肝转移的患者有益；而那些出现非神经内分泌肝转移的患者不被视为移植候选者。
