肝移植治疗原发性肝癌的价值

随着肝移植手术技术和术后管理水平的不断提高,肝移植治疗原发性肝癌的作用越来越受到关注。肝癌虽然可以作为肝移植的适应证之一,但是各个中心对选择肝癌肝移植的标准并不统一。国外在肝癌肝移植的适应证掌握方面比较严格,目前参照比较多的有米兰标准、加利福尼亚大学旧金山分校(UCSF)标准和匹兹堡标准。米兰标准和UCSF标准都严格限制肿瘤大小和数目,却未兼顾血管侵犯、组织学分化程度等影响预后的重要因素。浙江大学医学院附属第一医院肝移植中心提出了适合中国国情的肝癌肝移植标准(杭州标准),杭州标准超越了米兰标准,并在考虑了影响预后的多个危险因素的基础上安全地拓展了米兰标准,使更多的肝癌患者能接受肝移植治疗,且取得了和符合米兰标准患者相似的长期生存率。另外,本文还总结了肝癌肝移植的围手术期综合治疗,为减少肝移植术后肝癌复发、提高肝移植患者长期存活率,使肝移植真正成为治疗肝癌的重要方法。

Value of liver transplantation in hepatocellular carcinoma treatment

Along with the improvement of surgical techniques and post-transplant management,the role of liver transplantation in hepatocellular carcinoma(HCC) treatment has become increasingly important.Although HCC now is an indication of liver transplantation,the criteria of HCC candidates selection vary in different transplantation centers in China.On the contrary,the HCC candidates selection criteria in western countries are relatively strict,among which Milan criteria,University of California,San Francisco(UCSF) criteria,and Pittsburgh modified TNM criteria are widely acknowledged.However,Milan criteria and UCSF criteria only focus on tumor diameter and tumor number but ignore some important risk factors such as vascular invasion and histological differentiation.In our opinion,the biological behaviors of tumor are as important as tumor burden.A set of new candidates selection and prognostic criteria of liver transplantation in HCC patients named "Hangzhou criteria" has been established based on China's real situations and on the results of our long-term research.Hangzhou criteria expands and surpasses Milan criteria,including several important risk factors.According to Hangzhou criteria,more HCC patients are given opportunities to receive liver transplantation and achieved favorable long-term survival.Also in this article,we reviewed the peri-transplantation therapy of HCC to reduce the tumor recurrence and improve the long-term survival after transplantation for the purpose of making liver transplantation more effective and reliable for HCC treatment.