肝癌肝移植适应证的科学演进  

Scientific evolution of indications for liver transplantation in hepatocellular carcinoma

作　　者：沈未 鲁迪 徐骁 Shen Wei;Lu Di;Xu Xiao(School of Medicine,Zhejiang University,Hangzhou 310012,China;不详)

机构地区：[1]浙江大学医学院,杭州310012 [2]杭州医学院

出　　处：《器官移植》2025年第2期202-207,共6页Organ Transplantation

基　　金：国家自然科学基金重大研究计划(92159202);浙江省科技厅“尖兵领雁+X”研发攻关计划(2024C03051);国家中医药综合改革示范区中医药科技共建项目(GZY-KJS-ZJ-2025-002)。

摘　　要：肝癌是世界性的高发恶性肿瘤,也是我国肝移植的主要适应证。移植病人精细化分类推动了肝癌肝移植适应证演进,是实现精准肝移植的关键。肿瘤大小和数量一直以来是限制移植病人准入的重要临床参数,单细胞、空间转录组学等技术的发展进一步揭示了肝癌的时空异质性。分子标志物纳入肝癌肝移植标准是一个里程碑式的进步,基于双分子标志物的分类体系可在保证疗效的同时进一步扩大肝移植适宜人群。近年来,以免疫治疗为代表的肝癌综合诊疗模式有了长足发展,移植术前降期治疗体系日益成熟,更多原本不适宜移植的病人转变为适宜。人工智能技术的兴起也为病人筛选分类、预后评判和个体化治疗提供了新的工具,进一步推动了肝癌肝移植的精准化进程。因此,本文就肝癌肝移植适应证的科学演进以及人工智能革新肝癌肝移植疗效方面进行评述,以使更多的肝癌病人受益。Hepatocellular carcinoma(HCC)is a highly prevalent malignant tumor worldwide and also the main indication for liver transplantation in China.The refined classification of transplant recipients has driven the evolution of indications for liver transplantation in HCC and is key to achieving precise liver transplantation.Tumor number and size have always been important clinical parameters limiting the eligibility of transplant recipients.The development of single-cell and spatial transcriptomics has further revealed the spatiotemporal heterogeneity of HCC.The incorporation of molecular markers into the criteria for liver transplantation in HCC represents a milestone.A classification system based on dual molecular markers can expand the pool of suitable candidates for liver transplantation while ensuring therapeutic efficacy.In recent years,the comprehensive diagnosis and treatment model for HCC represented by immunotherapy has made significant progress.The pre-transplant downstaging treatment system has become increasingly mature,allowing more patients who were previously unsuitable for transplantation to become eligible.The rise of artificial intelligence technology has also provided new tools for patient screening,classification,prognostic evaluation,and personalized treatment,further promoting the precision of liver transplantation in HCC.Therefore,this article reviews the scientific evolution of indications for liver transplantation in HCC and the role of artificial intelligence in revolutionizing the outcomes of liver transplantation for HCC patients,with the aim of benefiting more patients with HCC.

关 键 词：肝癌 肝移植 适应证 甲胎蛋白 维生素K缺乏或拮抗剂诱导的蛋白-Ⅱ 门静脉癌栓 复发 人工智能 

分 类 号：R617[医药卫生—外科学] R735.7[医药卫生—临床医学]