From the Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Exp Clin Transplant. 2022 Feb;20(2):113-121. doi: 10.6002/ect.2021.0421.
Liver transplant is emerging as a potential treatment option for patients with isolated colorectal liver metastasis. In this review article, we analyzed the published literature on liver transplant outcomes in such patients.
Four prospective studies documenting the clinical outcomes in patients with colorectal liver metastasis who underwent liver transplant were analyzed to study the feasibility of liver transplant in such patients.
The SECA-II trial demonstrated the highest overall survival of 100%, 83%, and 83% at 1, 3, and 5 years, respectively, and disease-free survival of 53%, 44%, and 35%, respectively, with a narrow inclusion criterion. Conversely, extended criteria for selection and donors in arm D of the same trial resulted in median overall survival and disease-free survival of 18 and 4 months, respectively.
Liver transplant provided more prolonged overall survival compared with other therapeutic modalities. Patients with isolated colorectal liver metastasis of less aggressive biology, good performance status, at least 6 weeks of chemotherapy, low clinical risk scores, and negative nodal disease should be considered for patient selection. Moreover, exclusion criteria consisting of patients with the right-sided primary tumor, less than 3 years to liver transplant after diagnosis, and elevation of carbohydrate antigen (CA19-9) in the presence of BRAF mutation should be explored.
肝移植作为一种治疗孤立性结直肠肝转移的潜在方法正在出现。在这篇综述文章中，我们分析了已发表的关于此类患者接受肝移植的文献，以研究肝移植在这些患者中的可行性。
分析了四项前瞻性研究，这些研究记录了接受肝移植的结直肠肝转移患者的临床结果，以研究肝移植在这些患者中的可行性。
SECA-II 试验显示出最高的总体生存率，分别为 100%、83%和 83%，1、3 和 5 年无病生存率分别为 53%、44%和 35%，纳入标准严格。相比之下，同一试验的 D 臂中对选择和供体的扩展标准导致中位总生存率和无病生存率分别为 18 个月和 4 个月。
与其他治疗方法相比，肝移植提供了更持久的总体生存率。对于具有侵袭性生物学、良好表现状态、至少 6 周化疗、低临床风险评分和阴性淋巴结疾病的孤立性结直肠肝转移患者，应考虑进行患者选择。此外，还应探索排除标准，包括右半原发性肿瘤、诊断后至肝移植的时间少于 3 年以及存在 BRAF 突变时糖抗原（CA19-9）升高。
