Liver Transplantation and Surgery in the Management of Hepatocellular Carcinoma

Q4 Medicine
M. Malágo, D. Raptis, C. Imber, Giovanni Dalla Serra, O. Kornasiewicz
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引用次数: 0

Abstract

Hepatocellular carcinoma (HCC) is the second cause of cancer–related deaths worldwide constitutes a major global health problem. Although our understanding of the molecular pathogenesis of hepatocellular HCC has improved, detected driver mutations are not yet sufficiently reliable therapeutic targets. The modern management of HCC is conceived only within multidisciplinary schemes. Current systemic therapies are not curative and surgical treatments remain the only potential curative treatments for selected patients with early stage HCC. The role of parenchyma sparing liver resection for appropriately selected patients may vary in different environments according to organ availability,and liver resection remains a reliable curative method for HCC. Meta-analyses have shown that clinical outcomes of surgical resection are superior to ablative treatments in early stage HCC. Liver transplantation is still the standard treatment for patients with early stage HCC. Lately the Milan Criteria are considered too restrictive, still recognizing that the extension of transplantation criteria beyond Milano criteria increases the risk of HCC recurrence. Resection, ablation, transarterial embolization and trans-arterial radiation are commonly applied to bridge patients to transplant. Despite enormous advances in the therapy of HCC treatments at present, there are currently no genuine breakthroughs for patients with HCC. The Clinical Trials Planning Meeting (CTPM) in HCC convened by the American Society of Clinical Oncology identified the key knowledge gaps in HCC and define clinical research priorities. Major improvements in survival provided by multimodal treatments witnessed in other cancers are not yet available for HCC because effective systemic treatment modalities for HCC are still lacking. Integration of bio-genetic tumor information into current tested treatment schemes and truly multimodal surgery-based treatment schemes will enable the recruitment of less selected patients in larger numbers to curative treatments.
肝移植和手术治疗肝细胞癌
肝细胞癌(HCC)是全球癌症相关死亡的第二大原因,构成了一个重大的全球健康问题。虽然我们对肝细胞性HCC的分子发病机制的了解有所提高,但检测到的驱动突变还不够可靠的治疗靶点。HCC的现代管理只能在多学科方案中构想。目前的全身治疗无法治愈,手术治疗仍然是早期HCC患者的唯一潜在治疗方法。根据器官可用性的不同,在不同的环境下,适当选择保留实质的肝切除术对患者的作用可能会有所不同,肝切除术仍然是HCC的可靠治疗方法。荟萃分析显示,在早期HCC中,手术切除的临床效果优于消融治疗。肝移植仍是早期HCC患者的标准治疗方法。最近米兰标准被认为过于严格,仍然认识到移植标准超出米兰标准会增加HCC复发的风险。切除、消融术、经动脉栓塞和经动脉放射治疗通常用于架桥患者进行移植。尽管目前HCC的治疗方法取得了巨大的进步,但对于HCC患者来说,目前还没有真正的突破。由美国临床肿瘤学会召集的HCC临床试验计划会议(CTPM)确定了HCC的关键知识缺口并确定了临床研究重点。由于目前还缺乏有效的肝细胞癌的全身治疗方式,因此在其他癌症中发现的多模式治疗对肝细胞癌生存率的重大改善尚不可用于肝细胞癌。将肿瘤生物遗传信息整合到目前已测试的治疗方案和真正的基于多模式手术的治疗方案中,将使较少选择的患者能够更多地接受治愈性治疗。
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来源期刊
Surgery, Gastroenterology and Oncology
Surgery, Gastroenterology and Oncology Medicine-Gastroenterology
CiteScore
0.30
自引率
0.00%
发文量
11
期刊介绍: Starting with this issue "Annals of Fundeni Hospital", founded in 1996 as the scientific journal of the prestigious hospital Fundeni becomes "Journal of Translational Medicine and Research" (JTMR), an Journal of the Academy of Medical Sciences of Romania. Therefore, an 18 years old Journal, attested and indexed in Elsevier Bibliographic Databases, Amsterdam and also indexed in SCOPUS, is continuing a tradition of excellence that lasted almost two decades. The new title of the Journal is inspired first of all from the important developments of translational research In Fundeni Clinical Institute and the "C.C Iliescu Institute for Cardio-Vascular Diseases", in parallel with the national and international trend to promote and develop this important area or medical research. Although devoted mainly to translational research, JTMR will continue to promote both basic and clinical research.
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