Expanding indications for liver transplantation in the era of liver transplant oncology.
Expanding indications for liver transplantation in the era of liver transplant oncology.
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DOI：
10.4240/wjgs.v13.i5.392
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发表时间：
2021-05-27
影响因子：
2
通讯作者：
Pyrsopoulos N
中科院分区：
文献类型：
--
作者：
Panayotova G;Lunsford KE;Latt NL;Paterno F;Guarrera JV;Pyrsopoulos N
尽管有许多进展和新出现的数据，肝移植在胃肠道恶性肿瘤的设置仍然存在一些公认的适应症以外的争议。在器官持续短缺和器官需求增加的时代，肝脏移植的分配必须慎重考虑。虽然肝细胞癌和肝门胆管癌已成为公认的移植适应症，但肿瘤大小和标准化的多学科治疗方案是确保最佳患者预后的必要条件。随着越来越多的研究寻求扩大肝移植的肿瘤适应症，越来越清楚的是，肿瘤生物学和对治疗的反应是最佳肿瘤预后的关键因素。此外，从诊断到移植的时间似乎与生存相关，因为随着时间的推移，疾病的稳定预示着术后更好的结果。在目前的成像和组织采样技术下，确定移植前的侵袭性疾病仍然很困难。虽然肿瘤大小和分期是大多数恶性肿瘤的重要预后预测因素，但患者和肿瘤选择方案是必要的。随着内科和外科肿瘤领域的不断发展，很明显，一种协议化的跨学科治疗方法对于有效地对抗任何癌症都是必要的。随着时间的推移，疾病的稳定性和对新辅助治疗的反应可能是成功患者预后的最佳预测因素，可以很容易地纳入我们的治疗范例。目前评估肝移植用于扩大肿瘤适应症的数据，如：扩大标准的肝细胞癌、肝内胆管癌、混合肿瘤和肝局限性转移性结直肠癌，纳入了多模式治疗和肿瘤治疗反应的评估。虽然需要进一步的研究，但初步结果表明，在肝移植肿瘤学的新时代，移植手术在恶性肿瘤中的作用扩大了。
Despite numerous advances and emerging data, liver transplantation in the setting of gastrointestinal malignancies remains controversial outside of certain accepted indications. In an era of persistent organ shortage and increasing organ demand, allocation of liver grafts must be considered carefully. While hepatocellular carcinoma and hilar cholangiocarcinoma have become accepted indications for transplantation, tumor size and standardized multi-disciplinary treatment protocols are necessary to ensure optimal patient outcomes. As more studies seeking to expand the oncologic indications for liver transplantation are emerging, it is becoming increasingly clear that tumor biology and response to therapy are key factors for optimal oncologic outcomes. In addition, time from diagnosis to transplantation appears to correlate with survival, as stable disease over time portends better outcomes post-operatively. Identifying aggressive disease pre-transplant remains difficult with current imaging and tissue sampling techniques. While tumor size and stage are important prognostic predictors for most malignancies, patient and tumor selection protocols are necessary. As the fields of medical and surgical oncology continue to evolve, it is clear that a protocolized interdisciplinary treatment approach is necessary for combatting any cancer effectively. Disease stability over time and response to neoadjuvant therapy may be the best predictors for successful patient outcomes and can be easily incorporated in our treatment paradigms. Current data evaluating liver transplantation for expanded oncologic indications such as: expanded criteria hepatocellular carcinoma, intrahepatic cholangiocarcinoma, mixed tumors, and liver limited metastatic colorectal carcinomas, incorporate multi-modal therapies and evaluation of tumor treatment response. While further investigation is necessary, initial results suggest there is an expanded role for transplant surgery in malignancy in a new era of liver transplant oncology.
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影响因子：
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作者：
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通讯作者：
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影响因子：
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DOI：
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发表时间：
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影响因子：
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通讯作者：
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