Badwei Nourhan
Department of Tropical Medicine, Gastroenterology and Hepatology, Hepatoma Group, Ain Shams University, Cairo 11517, Egypt.
World J Transplant. 2024 Sep 18;14(3):96637. doi: 10.5500/wjt.v14.i3.96637.
Hepatocellular carcinoma (HCC) is a common liver malignancy and represents a serious cause of cancer-related mortality and morbidity. One of the favourable curative surgical therapeutic options for HCC is liver transplantation (LT) in selected patients fulfilling the known standard Milan/University of California San Francisco criteria which have shown better outcomes and longer-term survival. Despite careful adherence to the strict HCC selection criteria for LT in different transplant centres, the recurrence rate still occurs which could negatively affect HCC patients' survival. Hence HCC recurrence post-LT could predict patients' survival and prognosis, depending on the exact timing of recurrence after LT (early or late), and whether intra/extrahepatic HCC recurrence. Several factors may aid in such a complication, particularly tumour-related criteria including larger sizes, higher grades or poor tumour differentiation, microvascular invasion, and elevated serum alpha-fetoprotein. Therefore, managing such cases is challenging, different therapeutic options have been proposed, including curative surgical and ablative treatments that have shown better outcomes, compared to the palliative locoregional and systemic therapies, which may be helpful in those with unresectable tumour burden. To handle all these issues in our review.
肝细胞癌（HCC）是一种常见的肝脏恶性肿瘤，是癌症相关死亡率和发病率的一个重要原因。对于HCC，一种理想的根治性手术治疗选择是对符合已知标准的米兰/加利福尼亚大学旧金山分校标准的特定患者进行肝移植（LT），这已显示出更好的治疗效果和更长的生存期。尽管不同移植中心在LT时严格遵循严格的HCC选择标准，但复发率仍然存在，这可能会对HCC患者的生存产生负面影响。因此，LT后HCC复发可预测患者的生存和预后，这取决于LT后复发的确切时间（早期或晚期），以及是否为肝内/肝外HCC复发。几个因素可能导致这种并发症，特别是肿瘤相关标准，包括更大的尺寸、更高的分级或较差的肿瘤分化、微血管侵犯和血清甲胎蛋白升高。因此，处理此类病例具有挑战性，已经提出了不同的治疗选择，包括根治性手术和消融治疗，与姑息性局部和全身治疗相比，这些治疗已显示出更好的效果，姑息性局部和全身治疗可能对那些肿瘤负荷不可切除的患者有帮助。在我们的综述中处理所有这些问题。
