Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths. Classically, liver transplantation (LT) can be curative for HCC tumors within the Milan criteria. Bridging strategies to reduce the dropouts from LT waiting lists and/or to downstage patients who are beyond the Milan criteria are widely utilized. We conducted a literature-based review to evaluate the role of systemic therapies as a bridging treatment to liver transplantation (LT) in HCC patients. Tyrosine kinase inhibitors (TKIs) can be used as a systemic bridging therapy to LT in patients with contraindications for locoregional liver-directed therapies. Immune checkpoint inhibitor (ICI) treatment can be utilized either as a monotherapy or as a combination therapy with bevacizumab or TKIs prior to LT. Acute rejection after liver transplantation is a concern in the context of ICI treatment. Thus, a safe ICI washout period before LT and cautious post-LT immunosuppression strategies are required to reduce post-LT rejections and to optimize clinical outcomes. Nevertheless, prospective clinical trials are needed to establish definitive conclusions about the utility of systemic therapy as a bridging modality prior to LT in HCC patients.
肝细胞癌（HCC）是癌症相关死亡的第三大常见原因。传统上，符合米兰标准的HCC肿瘤可通过肝移植（LT）实现治愈。为减少肝移植等待名单脱落率和/或对超出米兰标准的患者进行降期治疗，桥接策略已被广泛应用。本文通过文献综述，评估了全身性疗法作为HCC患者肝移植桥接治疗的作用。对于存在局部肝脏定向治疗禁忌症的患者，酪氨酸激酶抑制剂（TKIs）可作为肝移植前的全身性桥接疗法。免疫检查点抑制剂（ICI）治疗可在肝移植前作为单药疗法，或与贝伐珠单抗或TKIs联合使用。肝移植后的急性排斥反应是ICI治疗中需要关注的问题。因此，需要在肝移植前设置安全的ICI洗脱期，并采取谨慎的移植后免疫抑制策略，以减少移植后排斥反应并优化临床结局。尽管如此，仍需开展前瞻性临床试验，以明确全身性疗法作为HCC患者肝移植前桥接治疗模式的效用。
肿瘤(癌症)患者之家