Zhang Xu, Chen Chi, Wang Yan, Xu Jun
Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China.
Department of Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.
J Gastroenterol Hepatol. 2024 Nov;39(11):2272-2280. doi: 10.1111/jgh.16693. Epub 2024 Aug 7.
Liver transplantation (LT) is an effective method for curing hepatocellular carcinoma (HCC). However postoperative tumor recurrence can lead to higher mortality rates. To select suitable candidates for LT, the Milan Criteria (MC) were first proposed based on tumor morphological characteristics. For those patients who meet the MC, the MC can effectively reduce the postoperative tumor recurrence rate and improve the prognosis of patients undergoing LT. It has always been internationally recognized as the gold standard for selecting candidates for LT, marking a milestone in the history of LT for HCC. However, its strict conditions exclude some HCC patients who could benefit from LT. Therefore, comprehension consideration criteria, including serum biomarkers, tumor histology, and other factor, have been continuously proposed in addition to tumor morphology. This article summaries the prediction model for HCC recurrence after LT from five aspects: tumor morphology, serum markers, histopathology, cellular inflammatory factors and downstaging treatment before transplantation. The aim is to assist clinicians in accurately assessing HCC status, selecting appropriate liver transplant candidates, maximize graft and patients' survival, and optimizing the utilization of social health resources.
肝移植（LT）是治疗肝细胞癌（HCC）的有效方法。然而，术后肿瘤复发会导致更高的死亡率。为了选择合适的肝移植候选人，最初基于肿瘤形态特征提出了米兰标准（MC）。对于符合MC的患者，MC可以有效降低术后肿瘤复发率，并改善接受肝移植患者的预后。它一直被国际公认为选择肝移植候选人的金标准，标志着HCC肝移植史上的一个里程碑。然而，其严格的条件排除了一些可能从肝移植中受益的HCC患者。因此，除了肿瘤形态学之外，还不断提出包括血清生物标志物、肿瘤组织学和其他因素在内的综合考虑标准。本文从肿瘤形态学、血清标志物、组织病理学、细胞炎症因子和移植前降期治疗五个方面总结了肝移植后HCC复发的预测模型。目的是协助临床医生准确评估HCC状况，选择合适的肝移植候选人，最大限度地提高移植物和患者的生存率，并优化社会卫生资源的利用。
