Liver transplantation for malignancy
Liver transplantation for malignancy
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DOI：
10.1634/theoncologist.10-4-269
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发表时间：
2005-04-01
期刊：
影响因子：
5.8
通讯作者：
Cosimi, AB
中科院分区：
文献类型：
--
作者：
Hertl, M;Cosimi, AB
肝移植治疗肝脏恶性肿瘤已经从一个异国情调和绝望的方法出现，为这些不幸的患者提供了一个有充分记录和证明的治疗方式。然而，早期不令人满意的结果强调，只有高度选择的患者群体将受益于移植。目前，所有肝移植中<10%是针对肝细胞癌（HCC）进行的。毫无争议，肝母细胞瘤是儿科不可切除肿瘤患者的良好适应症。同样，对于肿瘤质量不超过米兰标准的患者，成人肝移植治疗HCC也能获得良好的结果。仍有待确定的是，是否可以可靠地选择具有更广泛肿瘤的患者从该手术中受益。辅助手术如射频消融、化疗栓塞或冷冻治疗可能适用于限制等待名单上患者的肿瘤进展。与血管肉瘤不同，上皮样血管内皮瘤也是肝移植的合适指征。转移性肝病不是肝移植的适应症，但原发性为神经内分泌肿瘤的病例除外，肝移植可使许多患者长期存活甚至治愈。最后，虽然胆囊癌从来不是肝移植的指征，但如果进行积极的联合治疗，包括化疗和放疗，然后进行奥尔特，罕见的胆管细胞癌病例可能符合条件。这些选定患者的生存率接近胆汁淤积性肝病患者。
Liver transplantation for hepatic malignancies has emerged from an exotic and desperate approach to a well-documented and proven treatment modality for these unfortunate patients. However, early unsatisfactory results emphasized that only a highly selected patient population would benefit from transplantation. Currently, < 10 % of all liver transplants performed are for hepatocellular cancer (HCC). There is no controversy that hepatoblastoma is an excellent indication in pediatric patients with unresectable tumors. Similarly, liver transplantation for HCC in the adult population yields good results for patients whose tumor masses do not exceed the Milan criteria. It remains to be determined whether patients with more extensive tumors can be reliably selected to benefit from the procedure. Adjunctive procedures like radiofrequency ablation, chemoembolization, or cryotherapy might be indicated to limit tumor progression for patients on waiting lists. Epitheloid hemangioendothelioma is also an appropriate indication for liver transplantation, unlike angiosarcoma. Metastatic liver disease is not an indication for liver transplantation, with the exception of cases in which the primary is a neuroendocrine tumor, for which liver transplantation can result in long-term survival and even cure in a number of patients. And finally, while gallbladder cancers are never an indication for liver transplantation, rare cases of cholan-giocellular cancer might qualify if aggressive combination therapies, including chemotherapy and radiotherapy followed by OLT, are carried through. Survival in these selected patients can approach that for patients with cholestatic liver disease.