Hepatocellular carcinoma (HCC) is one of the leading causes of liver transplant worldwide. While liver transplantation offers a survival advantage for early-stage HCC patients, post-transplant recurrence remains a significant concern, affecting up to 15% of recipients. We sought to conduct a comprehensive review related to HCC recurrence after liver transplant. Tumor-related factors such as poor differentiation, vascular invasion, and elevated tumor biomarkers like alpha-fetoprotein are key predictors of recurrence. Donor-related factors, including graft type and surgical procedures, can also influence outcomes, though their effects are less conclusive. Advancements in patient selection criteria and scoring systems, such as the Milan Criteria and RETREAT score, have improved risk stratification by incorporating tumor size, biomarkers, and response to pre-transplant treatment. Despite these measures, recurrent HCC after transplantation poses treatment challenges. Curative approaches such as resection are feasible for localized or oligometastatic recurrence and offer the best outcomes when applicable. Locoregional treatments, including ablation and transarterial chemoembolization, provide options for unresectable cases but have limited long-term efficacy. Systemic therapies, including targeted agents like sorafenib, regorafenib, and lenvatinib, have shown modest benefits in managing advanced recurrent HCC. Emerging immunotherapy approaches hold promise but face unique challenges due to the required immunosuppression in transplant recipients. Multidisciplinary evaluation remains essential for tailoring treatment plans. Future efforts should focus on refining predictive tools and exploring novel therapies to improve survival outcomes for patients with recurrent HCC after liver transplantation.
肝细胞癌是全球范围内肝移植的主要适应症之一。虽然肝移植为早期肝癌患者提供了生存优势，但移植后复发仍是重要临床问题，影响高达15%的受者。本文旨在系统综述肝移植后肝癌复发的相关研究。肿瘤相关因素如低分化、血管侵犯及甲胎蛋白等肿瘤标志物升高是复发的主要预测指标。供体相关因素（包括移植物类型和手术方式）也会影响预后，但其作用尚不明确。米兰标准、RETREAT评分等患者选择标准和评分系统的进步，通过整合肿瘤大小、生物标志物及移植前治疗反应，提升了风险分层能力。尽管采取这些措施，移植后肝癌复发仍面临治疗挑战。对于局部或寡转移复发，手术切除等根治性手段具有可行性，并能提供最佳预后。消融和经动脉化疗栓塞等局部治疗为不可切除病例提供了选择，但长期疗效有限。索拉非尼、瑞戈非尼和仑伐替尼等靶向药物在内的全身治疗在晚期复发肝癌管理中显示出一定疗效。新兴免疫疗法前景广阔，但因移植受者需要免疫抑制而面临特殊挑战。多学科评估对制定个体化治疗方案至关重要。未来应致力于完善预测工具并探索新型疗法，以改善肝移植后复发肝癌患者的生存结局。
肿瘤(癌症)患者之家