Jiang Chao, Sun Xiao-Dong, Qiu Wei, Chen Yu-Guo, Sun Da-Wei, Lv Guo-Yue
General Surgery Center, Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, Changchun 130021, China.
General Surgery Center, Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, Changchun 130021, China.
Hepatobiliary Pancreat Dis Int. 2023 Feb;22(1):7-13. doi: 10.1016/j.hbpd.2022.10.006. Epub 2022 Oct 20.
Hepatocellular carcinoma (HCC) is the sixth most common cancer globally, with limited therapies and unsatisfactory prognosis once in the advanced stages. With promising advances in locoregional and systematic treatments, fast development of targeted drugs, the success of immunotherapy, as well as the emergence of the therapeutic alliance, conversion therapy has recently become more well developed and an effective therapeutic strategy. This article aimed to review recent developments in conversion therapy in liver transplantation (LT) for HCC.
We searched for relevant publications on PubMed before September 2022, using the terms "HCC", "liver transplantation", "downstaging", "bridging treatment" and "conversion therapy."
Conversion therapy was frequently represented as a combination of multiple treatment modalities to downstage HCC and make patients eligible for LT. Although combining various local and systematic treatments in conversion therapy is still controversial, growing evidence has suggested that multimodal combined treatment strategies downstage HCC in a shorter time, which ultimately increases the opportunities for LT. Moreover, the recent breakthrough of immunotherapy and targeted therapy for HCC also benefit patients with advanced-stage tumors.
In the era of targeted therapy and immunotherapy, applying the thinking of transplant oncology to benefit HCC patients receiving LT is a new topic that has shed light on advanced-stage patients. With the expansion of conversion therapy concepts, further investigation and research is required to realize the full potential of conversion treatment strategies, including accurately selecting candidates, determining the timing of surgery, improving the conversion rate, and guaranteeing the safety and long-term efficacy of treatment.
肝细胞癌（HCC）是全球第六大常见癌症，一旦进入晚期，治疗手段有限且预后不理想。随着局部区域和系统治疗取得有前景的进展、靶向药物的快速发展、免疫治疗的成功以及治疗联盟的出现，转化治疗最近变得更加成熟且成为一种有效的治疗策略。本文旨在综述肝细胞癌肝移植（LT）中转化治疗的最新进展。
我们在2022年9月之前在PubMed上搜索了相关出版物，使用了“HCC”“肝移植”“降期”“桥接治疗”和“转化治疗”等术语。
转化治疗通常表现为多种治疗方式的组合，以降低HCC分期并使患者符合LT条件。尽管在转化治疗中联合各种局部和系统治疗仍存在争议，但越来越多的证据表明，多模式联合治疗策略能在更短时间内降低HCC分期，最终增加LT的机会。此外，HCC免疫治疗和靶向治疗的最新突破也使晚期肿瘤患者受益。
在靶向治疗和免疫治疗时代，应用移植肿瘤学的思路使接受LT的HCC患者受益是一个新课题，为晚期患者带来了希望。随着转化治疗概念的扩展，需要进一步的调查和研究以充分发挥转化治疗策略的潜力，包括准确选择候选者、确定手术时机、提高转化率以及确保治疗的安全性和长期疗效。
