肝移植后肝细胞癌的复发

StephenW

Recurrence of hepatocellular carcinoma following liver transplantation
Daniel Hoffman & Neil Mehta
Received 11 Aug 2020, Accepted 10 Sep 2020, Accepted author version posted online: 16 Sep 2020, Published online: 23 Sep 2020

    Download citation https://doi.org/10.1080/17474124.2021.1823213 CrossMark Logo CrossMark

ABSTRACT
Introduction

Hepatocellular carcinoma (HCC) is an increasingly common disease with liver transplant (LT) the best long-term therapy for early stage disease. We will review the data for assessing risk and managing recurrence for patients undergoing LT for HCC.
Areas Covered

In this review, we will provide an overview of methods of patient risk stratification in the post-transplant period, the data around surveillance for HCC recurrence, and the evidence for and against post-LT adjuvant treatment strategies. Finally, we will provide data regarding treatment options for patients with HCC recurrence after LT. Using an extensive search of original papers and society guidelines, this paper provides a comprehensive review of the data for assessing risk and managing recurrence for patients undergoing LT for HCC.
Expert Opinion

The development of multiple post-transplant prognostic scoring systems have allowed for improved assessment of recurrence risk and stratification of patients. However, the ability to translate this information into surveillance and therapeutic strategies that improve patient outcomes still have to be fully demonstrated. Post-LT immunosuppression strategies have been implemented in order to attempt to reduce this risk. Evidence-based strategies for managing recurrent HCC are evolving. We expect that with further understanding of individual patient characteristics will allow for optimal therapeutic selection.
KEYWORDS: HCC, liver transplant, transplant oncology, immunosuppression, RETREAT, alpha-fetoprotein (AFP), immunotherapy, mammalian target of rapamycin (mTOR)

This paper was not funded.
Article highlights

    HCC prevalence is rising worldwide and it is an increasingly common reason for liver transplant

    Pre- and Post-Transplant scoring systems can help optimize risk stratification and guide follow up after OLT for HCC

    Increased surveillance may improve post-recurrence survival, though optimal surveillance strategies have yet to be proven

    Post-LT immunosuppression strategies to minimize recurrence include reducing CNIs. Whether there is a patient population that gains specific anti-tumor benefit from mTOR inhibitors has yet to be proven definitively.

    Patients with recurrent HCC benefit from treatment with curative intent, ranging from LRT to resection

    Systemic therapies for recurrent HCC include Sorafenib, Regorafenib, and traditional chemotherapy agents such as capecitabine. Immunotherapy has shown promising results but must be used with caution.

StephenW

肝移植后肝细胞癌的复发
丹尼尔·霍夫曼（Daniel Hoffman）和尼尔·梅塔（Neil Mehta）
于2020年8月11日接收，于2020年9月10日接受，在线接受作者版本：2020年9月16日，在线发布：2020年9月23日

    下载引文https://doi.org/10.1080/17474124.2021.1823213 CrossMark徽标CrossMark

抽象
介绍

肝细胞癌（HCC）是一种越来越常见的疾病，肝移植（LT）是早期疾病的最佳长期治疗方法。我们将审查数据，以评估接受LT进行HCC的患者的风险和管理复发。
覆盖区域

在这篇综述中，我们将概述移植后患者风险分层的方法，围绕HCC复发监测的数据以及支持和反对LT后辅助治疗策略的证据。最后，我们将提供有关LT后HCC复发患者的治疗选择的数据。通过对原始论文和社会指南的广泛搜索，本文对数据进行了全面的综述，以评估接受LT进行HCC的患者的风险和管理复发。
专家意见

多种移植后预后评分系统的发展已使对复发风险和患者分层的评估得以改善。但是，仍必须充分证明将这些信息转化为可改善患者预后的监测和治疗策略的能力。 LT后免疫抑制策略已经实施，以试图降低这种风险。正在发展基于证据的管理复发性肝癌的策略。我们希望，通过进一步了解患者的个性特征，可以进行最佳治疗选择。
关键词：肝癌，肝移植，移植肿瘤学，免疫抑制，退缩，甲胎蛋白（AFP），免疫治疗，雷帕霉素的哺乳动物靶点（mTOR）

该论文未获得资助。
文章重点

    全球HCC患病率正在上升，这是肝移植日益普遍的原因

    移植前和移植后评分系统可帮助优化风险分层并指导OLT进行HCC后的随访

    加强监视可能会改善复发后的生存率，尽管尚无最佳的监视策略

    最大限度地减少复发的LT后免疫抑制策略包括减少CNI。是否存在从mTOR抑制剂获得特异性抗肿瘤获益的患者人群尚未得到确切证实。

    复发性肝癌患者可受益于根治性治疗，从轻轨治疗到切除

    复发性HCC的系统疗法包括索拉非尼，瑞戈非尼和传统的化疗药物，如卡培他滨。免疫疗法已显示出令人鼓舞的结果，但必须谨慎使用。