Decaens T, Duvoux C
Service d'Hépato-gastroentérologie, Hôpital Henri Mondor, 51, av. du Maréchal de Lattre de Tassigny, 94010 Créteil cedex, France.
Gastroenterol Clin Biol. 2009 Nov;33 Suppl 4:S257-62. doi: 10.1016/S0399-8320(09)73163-X.
Liver transplantation is considered the best treatment of hepatocellular carcinoma but its efficacy depends on the risk of tumour recurrence. The risk of recurrence depends on tumour characteristics but is also influenced by immunosuppressive regimens. Immunosuppressants of the mTOR inhibitors family share anti-tumour properties which are already taken into account in the treatment of renal carcinoma and advanced hepatocellular carcinoma. These features make interesting their use in liver transplantation for hepatocellular carcinoma, with the following goals: to reduce the risk of post-transplant tumour recurrence, to expand the indications of liver transplantation for hepatocellular carcinoma and eventually to slow down tumour growth during the waiting period. However, to date, the potential role of mTOR inhibitors after liver transplantation for hepatocellular carcinoma is only based on small encouraging proof of concept studies. Large randomized studies are therefore required to further define the specific indications of these compounds. The demonstration of a beneficial impact of mTOR inhibitors in the setting of liver transplantation for hepatocellular carcinoma would be a major therapeutical advance.
肝移植被认为是肝细胞癌的最佳治疗方法，但其疗效取决于肿瘤复发风险。复发风险取决于肿瘤特征，但也受免疫抑制方案的影响。mTOR抑制剂家族的免疫抑制剂具有抗肿瘤特性，这在肾癌和晚期肝细胞癌的治疗中已被考虑在内。这些特性使得它们在肝细胞癌肝移植中的应用具有吸引力，目标如下：降低移植后肿瘤复发风险，扩大肝细胞癌肝移植的适应症，并最终在等待期减缓肿瘤生长。然而，迄今为止，mTOR抑制剂在肝细胞癌肝移植后的潜在作用仅基于一些令人鼓舞的小型概念验证研究。因此，需要大型随机研究来进一步明确这些化合物的具体适应症。证明mTOR抑制剂在肝细胞癌肝移植中具有有益影响将是一项重大的治疗进展。
