Zheng Shu-sen, Wu Jian
Department of Hepatobiliary Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2008 Aug;30(4):366-70.
Along with the improvement of surgical techniques and post-transplant management, the role of liver transplantation in hepatocellular carcinoma (HCC) treatment has become increasingly important. Although HCC now is an indication of liver transplantation, the criteria of HCC candidates selection vary in different transplantation centers in China. On the contrary, the HCC candidates selection criteria in western countries are relatively strict, among which Milan criteria, University of California, San Francisco (UCSF) criteria, and Pittsburgh modified TNM criteria are widely acknowledged. However, Milan criteria and UCSF criteria only focus on tumor diameter and tumor number but ignore some important risk factors such as vascular invasion and histological differentiation. In our opinion, the biological behaviors of tumor are as important as tumor burden. A set of new candidates selection and prognostic criteria of liver transplantation in HCC patients named "Hangzhou criteria" has been established based on China's real situations and on the results of our long-term research. Hangzhou criteria expands and surpasses Milan criteria, including several important risk factors. According to Hangzhou criteria, more HCC patients are given opportunities to receive liver transplantation and achieved favorable long-term survival. Also in this article, we reviewed the peri-transplantation therapy of HCC to reduce the tumor recurrence and improve the long-term survival after transplantation for the purpose of making liver transplantation more effective and reliable for HCC treatment.
随着手术技术和移植后管理的改进,肝移植在肝细胞癌(HCC)治疗中的作用变得越来越重要。虽然HCC现在是肝移植的一个适应证,但在中国不同的移植中心,HCC候选者的选择标准各不相同。相反,西方国家的HCC候选者选择标准相对严格,其中米兰标准、加利福尼亚大学旧金山分校(UCSF)标准和匹兹堡改良TNM标准被广泛认可。然而,米兰标准和UCSF标准只关注肿瘤直径和肿瘤数量,却忽略了一些重要风险因素,如血管侵犯和组织学分化。我们认为,肿瘤的生物学行为与肿瘤负荷同样重要。基于中国的实际情况和我们长期研究的结果,已经建立了一套名为“杭州标准”的HCC患者肝移植新的候选者选择和预后标准。杭州标准扩展并超越了米兰标准,包括几个重要风险因素。根据杭州标准,更多的HCC患者有机会接受肝移植并获得良好的长期生存。在本文中,我们还回顾了HCC的围移植期治疗,以减少肿瘤复发并提高移植后的长期生存,目的是使肝移植对HCC治疗更有效、更可靠。