移植肿瘤学与肝细胞癌肝移植的分层管理  

Transplant oncology and stratified management of hepatocellular carcinoma

作　　者：李林蔓 吕子成 冯浩 夏强[1,2,3] Li Linman;Lyu Zicheng;Feng Hao;Xia Qiang(Department of Liver Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Shanghai Institute of Transplantation,Shanghai 200127,China;Shanghai Engineering Research Center of Transplantation and Immunology,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院肝脏外科,上海200127 [2]上海市器官移植研究所,上海200127 [3]上海市器官移植与免疫工程技术研究中心,上海200127

出　　处：《国际外科学杂志》2022年第4期232-236,共5页International Journal of Surgery

基　　金：上海申康医院发展中心项目(SHDC22021309,SHDC2020CR5012);国家自然科学基金重大研究计划(92059205);国家自然科学基金面上项目(81972205)。

摘　　要：肝移植是治疗肝细胞癌的最佳方法之一,移植肿瘤学理念的提出为肝细胞癌患者的全过程管理带来新的思路。在过去,手术成功率和围术期安全是我们关注的重点,而随着肝细胞癌新辅助治疗和术后辅助治疗的推广,治疗的重心逐渐偏移到癌症治疗及提高患者生存率和生活质量上。不同类型的患者肝移植的预后可能会有所不同,因而应对肝细胞癌肝移植的患者进行细化分层和差异化的治疗路径,从而达到最佳治疗效果。本文将肝细胞癌肝移植患者分为符合移植标准的原发性肝细胞癌、肝切除术后复发的肝细胞癌和降期或新辅助治疗后的肝细胞癌患者。精细分层和分类管理是移植肿瘤学全过程管理的必然要求和必经路径。Liver transplantation is one of the best approaches for the treatment of hepatocellular carcinoma.The concept of transplant oncology could shed light on the whole process management of hepatocellular carcinoma patients.The success rate of operation and perioperative safety were the major concerns in the past,whereas the focus of treatment is gradually shifting to cancer treatment and improving patient survival and quality of life,with the promotion of neoadjuvant and postoperative adjuvant therapy for hepatocellular carcinoma.The prognosis of different group of patients might be heterogeneous.Therefore,refined stratification should be carried out for heterogeneous patients before and after liver transplantation to achieve the best prognosis.The present study classified patients for three clusters:primary hepatocellular carcinoma patients within the transplant criteria,hepatocellular carcinoma recurrence after liver resection,and patients after down-staging or neoadjuvant therapy.Fine stratified management are essential for the whole process management in the new era of transplant oncology.

关 键 词：肝肿瘤 肿瘤移植 肝移植 肝细胞癌 分层管理 全过程管理 

分 类 号：R735.7[医药卫生—肿瘤]