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[关于肝移植后肝细胞癌复发的见解与判断]

[Insight and judgment on recurrence of hepatocellular carcinoma after liver transplantation].

作者信息

Zheng H, Zhang H M, Zheng W P

机构信息

Department of Transplantation, Tianjin First Center Hospital, Tianjin 300192, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2018 Feb 20;26(2):88-92. doi: 10.3760/cma.j.issn.1007-3418.2018.02.003.

Abstract

Hepatocellular carcinoma (HCC) is the most important cause of adult liver transplantation in China. HCC recurrence after liver transplantation is a common clinical problem. It is imperative to explore its metastasis and recurrence mechanism and to develop effective prevention and treatment strategies. This article describes the basic prevention and treatment strategies for recurrent HCC after liver transplantation. During the pre-transplant period, the clinical and pathological information of HCC, such as tumor staging, general morphology, pathological features, tumor markers and tumor molecular biological characteristics, should be collected and analyzed carefully in order to determine the risk of recurrent HCC; Design and implement a comprehensive program of prevention and treatment. Currently, sorafenib and capecitabine are common candidate drugs for prevention and control of recurrence of HCC after liver transplantation. Substitution of m-TOR inhibitors for CNI-like drugs can be used as an immunosuppressive drug to prevent and control recurrence of HCC. HCC recurrence after liver transplantation will significantly reduce the cure rate, but active treatment often can effectively control the progression of the disease and improve the prognosis. However, available effective measures to prevent the progress of HCC can also be used to treat HCC recurrence after liver transplantation. Surgical treatment is preferred for recurrent lesions that can be resected, and local treatment is available for recurrent lesions that cannot be resected. Drug treatment can inhibit tumor growth to a certain extent, but it is difficult to achieve a satisfying prognosis by single drug, commonly used as adjuvant therapy.

摘要

肝细胞癌(HCC)是中国成人肝移植的最重要原因。肝移植后HCC复发是一个常见的临床问题。探索其转移和复发机制并制定有效的防治策略势在必行。本文介绍了肝移植后复发性HCC的基本防治策略。在移植前期,应仔细收集和分析HCC的临床和病理信息,如肿瘤分期、大体形态、病理特征、肿瘤标志物和肿瘤分子生物学特征,以确定复发性HCC的风险;设计并实施综合防治方案。目前,索拉非尼和卡培他滨是肝移植后预防和控制HCC复发的常用候选药物。用m-TOR抑制剂替代CNI类药物可作为免疫抑制药物来预防和控制HCC复发。肝移植后HCC复发会显著降低治愈率,但积极治疗往往能有效控制疾病进展并改善预后。然而,现有的预防HCC进展的有效措施也可用于治疗肝移植后HCC复发。对于可切除的复发病灶,首选手术治疗,对于不可切除的复发病灶,可采用局部治疗。药物治疗可在一定程度上抑制肿瘤生长,但单药治疗难以取得满意的预后,常用作辅助治疗。

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