免疫检查点抑制剂在肝细胞癌肝移植中的应用

Application of immune checkpoint inhibitors in liver transplantation for patients with hepatocellular carcinoma

肝移植作为肝细胞癌的根治性治疗策略之一,对米兰标准之内的患者有较好的临床效果。然而,术后高的复发率、转移率使得患者长期生存仍然面临挑战。因此,如何提高远期生存率,降低术后肿瘤转移成为亟待解决的关键难题。近年来,免疫检查点抑制剂(ICI)以其良好的安全性和客观反应性为晚期肝癌患者治疗提供了新的机遇,也成为了提高肝移植治疗效果的潜在方法。当前,早期临床研究已经报道了ICI单一及联合治疗在肝细胞癌肝移植术前降期或桥接治疗以及术后辅助治疗中的独特优势。本文旨在通过对近年来ICI在肝细胞癌肝移植中的临床试验及应用进展进行综述,并对其安全性和有效性进行探讨,以期为临床用药提供一定参考。

Liver transplantation,as one of the radical treatment strategies for hepatocellular carcinoma,has a good clinical effect in patients meeting the Milan criteria;however,the high recurrence rate and metastasis rate after surgery bring great challenges to the long-term survival of such patients.Therefore,how to improve long-term survival rate and reduce postoperative tumor metastasis has become a key problem that needs to be solved urgently.In recent years,immune checkpoint inhibitors(ICIs),with their good safety and objective reactivity,have provided a new opportunity for the treatment of patients with advanced liver cancer and have become potential candidates for improving the therapeutic effect of liver transplantation.At present,early clinical studies have reported the unique advantages of ICIs used alone or in combination in downstaging or bridging therapy before liver transplantation for hepatocellular carcinoma and adjuvant therapy after liver transplantation.Therefore,this article reviews the clinical trials of ICIs in liver transplantation for hepatocellular carcinoma and the advances in the application of ICIs in recent years and discuss its safety and efficacy,in order to provide a certain reference for clinical medication.