Bryce Kathleen, Tsochatzis Emmanuel A
UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
Transl Gastroenterol Hepatol. 2017 Dec 12;2:106. doi: 10.21037/tgh.2017.11.18. eCollection 2017.
Downstaging of hepatocellular carcinoma (HCC) to enable liver transplantation has become an area of intense interest and research. It may allow a curative option in patients outside widely accepted transplantation criteria, with outcomes that, in some studies, are comparable to transplantation for patients within criteria. There have been conflicting opinions on the best downstaging protocols, criteria for downstaging eligibility and for assessment of response. We therefore aimed to review the literature and evidence for downstaging, as well as considering its drawbacks.
Pooled analyses have suggested success in down staging in about half of patients treated, but with higher recurrence rates than patients initially within transplantation criteria. Studies with strict inclusion criteria and mandatory waiting time before transplantation reported survival equivalent to patients who did not require downstaging. In carefully selected patients, there is a role for down staging to provide the chance of transplantation and cure, with acceptable outcomes. Further multi center, well-designed studies are required to clarify who will mostly benefit. Until such data is available, downstaging criteria should be stated within transplantation programs and relevant decisions should be discussed by multidisciplinary teams.
将肝细胞癌（HCC）降期以实现肝移植已成为一个备受关注和深入研究的领域。这可能为不符合广泛接受的移植标准的患者提供一种治愈选择，在一些研究中，其结果与符合标准的患者接受移植的结果相当。关于最佳降期方案、降期资格标准以及反应评估，一直存在相互矛盾的观点。因此，我们旨在回顾有关降期的文献和证据，并考虑其缺点。
汇总分析表明，约一半接受治疗的患者降期成功，但复发率高于最初符合移植标准的患者。具有严格纳入标准和移植前强制等待时间的研究报告称，其生存率与不需要降期的患者相当。在精心挑选的患者中，降期可为移植和治愈提供机会，且结果可接受。需要进一步开展多中心、设计良好的研究，以明确谁将最受益。在获得此类数据之前，移植项目应明确降期标准，多学科团队应讨论相关决策。
