肝移植治疗不可切除的结直肠癌肝转移：全球方案、资格标准和移植导向患者评估工具（LT-CLEAR）的开发

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-09-01 DOI:10.1016/j.dld.2025.08.062

B. Sensi , R. Angelico , L. Toti , M. Alessi , G. D’arcangelo , J. Bloino , G. Tisone , T.M. Manzia

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引用次数: 0

摘要

背景：不可切除的结直肠癌肝转移（uCLRM）的肝移植（LT）在总体生存方面显示出良好的结果，并且该领域正在进行几项试验。我们的目的是对文献进行系统回顾，以确定正在进行的uCRLM的LT方案。截至2025年5月1日，所有关于uCRLM的LT试验（包括已完成的和/或仅发表的方案）都被纳入分析。该研究的目的是确定uCRLM患者LT的纳入/排除标准，并开发一个实用的在线网络工具，以方便选择符合LT条件的uCRLM患者。结果在纳入的27项研究中，23项（%）研究仍在进行试验，而8项（29.6%）试验已经发表了结果。uCRLM患者LT资格的选择标准与患者状态、原发肿瘤、继发肝脏疾病的程度、全身治疗和疾病趋势有关。52%的患者需要对原发灶进行根治性手术，而患者可能因切缘不足（11%）、晚期T（22%）或N分期（19%）而被排除。只有少数方案排除了原发直肠（7%）或右结肠（4%）的患者。主要的癌症相关排除标准是BRAF突变（52%的方案）、微卫星不稳定性（22%）和RAS（7%）。33%的试验将肝病变的大小作为选择标准，而仅4%的试验将肝病变的数量作为选择标准。67%的试验不允许肝外病变，而26%的试验接受可切除的肺部病变。在93%的方案中，系统治疗是强制性的，大多数方案需要稳定性（67%）或部分缓解（11%）。LT- clear是一种直观易用的在线工具，旨在供临床医生咨询，根据已发表的uCRLM移植试验的选择标准，确定uCRLM患者是否有资格接受肝移植。结论适合行肝移植的uCRLM患者的选择标准差异很大。由于uCRLM的肝移植方案越来越多，纳入标准不一，因此选择符合肝移植条件的uCRLM患者可能会让临床医生感到困惑。LT- clear是一种简单的工具，可以帮助选择合适的肝移植候选人，并可能有助于鼓励广泛考虑将肝移植作为uCRLM的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Liver Transplantation for Unresectable Colorectal Liver Metastases: Worldwide Protocol Eligibility Criteria and Development of a Transplant-oriented patient-evaluation Tool (LT-CLEAR)

Background

Liver transplantation(LT) for unresectable colorectal liver metastases(uCLRM)showed good outcomes in terms of overall survival, and the field is exploding with several trials. We aimed to

Methods

A systematic review of the literature was performed to identify ongoing protocols of LT for uCRLM. All trials (both completed and/or with only published protocol) on LT for uCRLM published until May 1, 2025 were included in the analysis. The aims of the study were to identify the inclusion/exclusion criteria for LT in patients with uCRLM and to develop a practical on-line web tool to easy select patients with uCRLM eligible to LT.

Results

Out of 27 studies included, 23 (%) studies were still ongoing trials, while 8 (29.6%) trials had already published results. Selection criteria for LT elegibility for patienst with uCRLM were related to patient status, primary cancer, the extent of secondary liver disease, systemic therapy and disease trend. Radical surgery of the primary was required in 52%, while patients could be excluded for inadequate margins(11%), advanced T(22%) or N(19%) staging. Only few protocols excluded patients with primary rectal(7%) or right-colon(4%) locations. Primary cancer-related exclusion criterion were BRAF mutation (in 52% of protocols), microsatellite instability (22%), and RAS (7%). The dimension of hepatic lesions was considered as a selecting criteria in 33% of trials, while the number of hepatic lesions was considered only in 4%. Extrahepatic disease was not admissible in 67%, while 26% of trials accepted resectable lung-lesions. Systemic-therapy was mandatory in 93% of protocols, with stability(67%) or partial-response(11%)required by most. The LT-CLEAR, an on-line intuitive and easy tool was developed intended for consultation by clinicians to define whether patients with uCRLM can be eligible for LT according to the selecting criteria of published trials of LT for uCRLM.

Conclusions

YSelection criteria for patients with uCRLM eligible for LT are wildly variable. Due to the increasing number of LT protocols for uCRLM with heterogenous inclusion criteria, selecting patients with uCRLM eligible to LT may be bewildering for clinicians. The LT-CLEAR is a simple tool that help in selecting eligible LT candidate and may prove useful to encourage widespread consideration of LT as a therapy for uCRLM.

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.