Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
Eur Rev Med Pharmacol Sci. 2017 Aug;21(15):3421-3435.
Hepatocellular Carcinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. Liver transplantation (LT) is an excellent treatment for patients with small HCC associated with cirrhosis. The purpose of this review is to investigate the possible strategies for the treatment of HCC recurrence after LT based on current clinical evidence.
A systematic literature search was performed independently by two of the authors using PubMed, EMBASE, Scopus and the Cochrane Library Central. The search was limited to studies in humans and to those reported in the English language.
Thanks to the introduction of strict selection criteria, LT for HCC has achieved a survival rate of 85% at five years. However, the recurrence of HCC after transplantation remains a serious problem that affects about 20% of post-transplant cases. While most recurrences occur within the first 2 years, late recurrences have been described. The prognosis of recurrence is poor despite numerous proposals of the therapeutic option. Lower levels of immunosuppressive therapy and use of mammalian targets of rapamycin (mTORs) is a potential preventive strategy to reduce HCC recurrence post-Lt. Surgical resection and locoregional therapies (mainly TACE and RFA) play a very important role and are associated with improved survival. Conversely, multikinase inhibitors such as Sorafenib and their association with mTOR inhibitors play a role in cases of advanced HCC recurrence not suitable for the surgical or ablative approach.
Treating HCC recurrence is a multidisciplinary workup involving hepatologists, surgeons, oncologists and radiologists in order to offer a patient-tailored therapy.
肝细胞癌（HCC）是全球第五大常见恶性肿瘤和第三大癌症相关死因。肝移植（LT）是治疗伴有肝硬化的小 HCC 的有效方法。本综述旨在根据现有临床证据，探讨 LT 后 HCC 复发的可能治疗策略。
两位作者独立使用 PubMed、EMBASE、Scopus 和 Cochrane Library Central 进行了系统文献检索。检索仅限于人类研究和英文报告的研究。
由于引入了严格的选择标准，LT 治疗 HCC 的五年生存率达到了 85%。然而，移植后 HCC 的复发仍然是一个严重的问题，约影响 20%的移植后病例。虽然大多数复发发生在移植后的前 2 年内，但也有晚期复发的描述。尽管提出了许多治疗选择方案，但复发的预后仍然很差。降低免疫抑制治疗水平和使用哺乳动物雷帕霉素靶蛋白（mTORs）是降低 LT 后 HCC 复发的潜在预防策略。手术切除和局部区域治疗（主要是 TACE 和 RFA）起着非常重要的作用，并与生存率的提高相关。相反，多激酶抑制剂如索拉非尼及其与 mTOR 抑制剂的联合应用在不适合手术或消融治疗的晚期 HCC 复发病例中具有一定的作用。
治疗 HCC 复发是一个多学科的工作，涉及肝病专家、外科医生、肿瘤学家和放射科医生，以提供个体化的治疗方案。
