Liver transplantation (LT) is one of the most effective treatments for hepatocellular carcinoma (HCC) in cirrhotic livers. Neoadjuvant bridging treatment in patients qualifying and listed for LT is advised but is still debatable owing to the low level of evidence. The aim of this study was to perform a systematic review to assess the prognostic value of bridging therapy, in terms of radiological and histopathological examination outcomes, for survival after LT. The systematic review was performed according to the PRISMA 2020 guidelines. The MEDLINE and Web of Science databases were searched. In total, five studies were included. An evaluation with the ROBINS-I resulted in studies classified as the following: moderate risk of bias (n= 1) and serious risk of bias (n= 4). The results of the analysis indicated that favorable LT outcomes were most common with complete response or partial radiological response. Poor radiological response or progressive disease during bridging treatment was generally associated with worse overall LT survival. There were not enough data to support the use of this approach to achieve a complete pathologic response. Radiological, pathological, histological, cellular, and molecular tumor features should be included in future LT qualification models.
肝移植是治疗肝硬化背景下肝细胞癌最有效的方法之一。对于符合条件并列入移植等待名单的患者，建议进行新辅助桥接治疗，但由于证据级别较低，这一策略仍存在争议。本研究旨在通过系统综述评估桥接治疗在肝移植术后生存方面的预后价值，重点关注影像学和组织病理学检查结果。本系统综述遵循PRISMA 2020指南，检索了MEDLINE和Web of Science数据库，最终纳入五项研究。采用ROBINS-I工具评估显示：一项研究存在中度偏倚风险，四项研究存在严重偏倚风险。分析结果表明，获得完全缓解或部分影像学缓解的患者肝移植预后最佳；而桥接治疗期间出现影像学缓解不佳或疾病进展通常与较差的总体移植生存率相关。目前尚无足够数据支持通过该策略实现完全病理学缓解。未来的肝移植资格评估模型应纳入肿瘤的影像学、病理学、组织学、细胞学及分子生物学特征。
肿瘤(癌症)患者之家