Wang Zhuo-Yi, Geng Lei, Zheng Shu-Sen
Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health; Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2015 Apr;14(2):145-9. doi: 10.1016/s1499-3872(15)60345-9.
Liver transplantation is the optimal treatment for a selected group of patients with moderate to severe cirrhosis and hepatocellular carcinoma (HCC). Despite the strict selection of candidates, post-transplant recurrence often occurs and markedly reduces the long-term survival of patients with HCC. The present review focuses on the current strategies on preventing the recurrence of HCC after liver transplantation.
Relevant articles were identified by extensive searching of PubMed using the keywords "hepatocellular carcinoma", "recurrence" and "liver transplantation" between January 1996 and January 2014. Additional papers were searched manually from the references in key articles.
The current theories of HCC recurrence after liver transplantation are: (i) the growth of pre-transplant occult metastases; (ii) the engraftment of circulating tumor cells released at the time of transplantation. Pre-transplant treatment aims to control local tumor by radiofrequency ablation, transarterial embolization and transarterial chemoembolization. The main objective during the operation is to prevent tumor cell dissemination. Post-transplant treatment includes systemic anticancer therapy, antiviral therapy, and most recently, immunotherapy. These strategies concentrate on the control of the tumor when the patients are waiting for transplant, to reduce the release of HCC cells during surgical procedures and to clear the occult HCC cells after transplantation.
Much can be done to prevent HCC recurrence after liver transplantation. In future, effort is likely to be directed towards combining multidisciplinary approaches and various treatment modalities.
肝移植是治疗部分中重度肝硬化和肝细胞癌（HCC）患者的最佳方法。尽管对候选者进行了严格筛选，但移植后复发仍经常发生，并显著降低了HCC患者的长期生存率。本综述聚焦于目前预防肝移植后HCC复发的策略。
通过在1996年1月至2014年1月期间使用关键词“肝细胞癌”“复发”和“肝移植”广泛检索PubMed来识别相关文章。另外从关键文章的参考文献中手动检索其他论文。
目前关于肝移植后HCC复发的理论有：（i）移植前隐匿性转移灶的生长；（ii）移植时释放的循环肿瘤细胞的植入。移植前治疗旨在通过射频消融、经动脉栓塞和经动脉化疗栓塞来控制局部肿瘤。手术中的主要目标是防止肿瘤细胞播散。移植后治疗包括全身抗癌治疗、抗病毒治疗以及最近的免疫治疗。这些策略集中于在患者等待移植时控制肿瘤，减少手术过程中HCC细胞的释放，并清除移植后的隐匿性HCC细胞。
在预防肝移植后HCC复发方面有很多工作可做。未来，可能会致力于将多学科方法和各种治疗方式相结合。
