Maspero Marianna, Sposito Carlo, Virdis Matteo, Citterio Davide, Pietrantonio Filippo, Bhoori Sherrie, Belli Filiberto, Mazzaferro Vincenzo
General Surgery and Liver Transplantation Unit, Medical Oncology and Colo-Rectal Surgery, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, 20133 Milan, Italy.
Cancers (Basel). 2023 Jan 5;15(2):345. doi: 10.3390/cancers15020345.
More than 40% of patients with colorectal cancer present liver metastases (CRLM) during the course of their disease and up to 50% present with unresectable disease. Without surgical interventions, survival for patients treated with systemic therapies alone is dismal. In the past, liver transplantation (LT) for patients with unresectable CRLM failed to show any survival benefit due to poor selection, ineffective chemotherapeutic regimens, unbalanced immunosuppression and high perioperative mortality. Since then and for many years LT for CRLM was abandoned. The turning point occurred in 2013, when the results from the Secondary Cancer (SECA I) pilot study performed at Oslo University were published reporting a 60% 5-year overall survival after LT in patients with unresectable CRLM. These results effectively reignited the interest in LT as a potential therapy for CRLM, and several trials are undergoing. The aims of this article are to give a comprehensive overview of the available evidence on LT for CRLM, discuss the open issues in this rapidly evolving field, and highlight possible ways to address the future of this fascinating therapeutic alternative for selected patients with CRLM.
超过40%的结直肠癌患者在病程中会出现肝转移（CRLM），高达50%的患者会出现不可切除的疾病。若不进行手术干预，仅接受全身治疗的患者生存率极低。过去，由于选择不当、化疗方案无效、免疫抑制失衡以及围手术期死亡率高，不可切除CRLM患者接受肝移植（LT）未能显示出任何生存获益。从那时起，多年来CRLM的LT被摒弃。转折点出现在2013年，当时奥斯陆大学进行的继发性癌症（SECA I）试点研究结果发表，报告了不可切除CRLM患者LT后5年总生存率为60%。这些结果有效地重新点燃了人们对LT作为CRLM潜在治疗方法的兴趣，并且多项试验正在进行中。本文的目的是全面概述关于CRLM的LT的现有证据，讨论这个快速发展领域中存在的未解决问题，并强调针对选定的CRLM患者探讨这种引人入胜的治疗选择的未来可能途径。
