构建以雷帕霉素为主预防肝癌肝移植术后肿瘤复发的综合防治体系

To establish a comprehensive prevention and treatment system based on rapamycin for cancer recurrence after liver transplantation

肝移植是肝癌,尤其是晚期肝癌的最有效的根治性手段,随着移植器官获取与移植手术的标准化发展,近5年我国肝癌肝移植的数量已远超美国。但是,术后复发与转移仍是限制远期疗效的关键问题。以钙调磷酸酶抑制剂为主的免疫抑制剂方案被认为是肝癌肝移植术后肿瘤复发的独立危险;避免激素与钙调磷酸酶抑制剂类药物长期的高暴露,早期雷帕霉素转化治疗是目前推荐的免疫抑制方案,然而,并未能改善3~5年的远期生存获益或获益较小,如何制定全面系统性、个性化的肝癌复发综合防治体系,最大优化雷帕霉素的有益生存效应,延缓肝癌的复发,是亟需解决的问题,本文旨在以肝癌、肝移植、靶向治疗、生物免疫治疗的最新成果为基础,探讨建立肝癌肝移植术后肿瘤复发综合防治体系的必要性。

Liver transplantation(LT)represents one of the most effective radical therapy for hepatocellular carcinoma(HCC),particularly for advanced HCC.With the standardized development of organ acquisition and transplantation,the number of LT for HCC in China has far exceeded that of the United States in the past five years.However,postoperative recurrence and metastasis remains the key issues to improve the long-term prognosis.Meanwhile,immunosuppressive regimens based on calcineurin inhibitors are considered to be an independent risk factor of tumor recurrence after LT for HCC,early rapamycin conversion therapy is currently recommended for immunosuppression in recommended so as to avoid long-term high exposure to hormones and calcineurin inhibitors.Nevertheless,this option failed to improve the long-term survival of 3 to 5 years or the benefit was limited.Therefore,it is important and urgent to establish a personalized comprehensive prevention and treatment system to maximize the survival benefit of rapamycin and delay the recurrence of HCC.Based on the recent progress of HCC treatment including LT,targeted therapy and biological immunotherapy,our study aims to explore the necessity of establishing a comprehensive prevention and treatment system of tumor recurrence after LT.