Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; NHC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China.
Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou 310003, China.
Transplant Rev (Orlando). 2021 Apr;35(2):100606. doi: 10.1016/j.trre.2021.100606. Epub 2021 Feb 5.
Liver transplantation (LT), one of the radical methods of treating liver cancer, has brought new hope for the treatment of unresectable liver cancer. Currently, patients who meet transplant criteria can achieve a favorable prognosis, but those who exceed transplant criteria tend not to have very satisfactory outcomes. For patients whose tumor burden exceeds the transplant criteria, downstaging treatment is a promising method to reduce tumor burden to within the transplant criteria that may lead to good posttransplant survival. Multiple treatments, such as transcatheter arterial chemoembolization (TACE), transarterial radioembolization (TARE), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA), have been used as downstaging treatments. However, there are still some issues that limit the effectiveness of downstaging treatments, such as the inclusion criteria for downstaging, which the choice of downstaging treatment method, and the endpoint of downstaging, all of which are worthy of further discussion. Based on the published literature, this review discusses these issues.
肝移植（LT）是治疗肝癌的一种激进方法，为不可切除肝癌的治疗带来了新的希望。目前，符合移植标准的患者可以获得良好的预后，但超过移植标准的患者往往没有非常满意的结果。对于肿瘤负荷超过移植标准的患者，降期治疗是一种有前途的方法，可以降低肿瘤负荷至移植标准范围内，从而可能获得良好的移植后生存。经导管动脉化疗栓塞（TACE）、经动脉放射性栓塞（TARE）、经皮乙醇注射（PEI）和射频消融（RFA）等多种治疗方法已被用作降期治疗。然而，仍存在一些限制降期治疗效果的问题，如降期的纳入标准、降期治疗方法的选择以及降期的终点等，这些都值得进一步讨论。基于已发表的文献，本文对这些问题进行了讨论。
