Despite improved therapeutic concepts, the survival of patients with hepatocellular carcinoma (HCC) is limited. Liver transplantation (LT) is the best possible treatment for suitable patients. This therapy is of particular importance, because it not only removes the cancer but also cures the underlying structural liver disease. Due to the persistent lack of donor organs, however, the oncological prognosis after LT is of particular importance for fair organ allocation. Bonus points on the organ waiting list are rewarded for tumors within a certain tumor extent. In general, macrovascular invasion and extrahepatic tumor manifestation are considered to be contraindications for LT, as survival in these patients is very low. In recent years, however, microvascular invasion and poorly differentiated tumors have also turned out to be unfavorable. Most selection criteria for LT in HCC are still based on very simple imaging criteria like size and number without utilizing additional imaging characteristics inherent to the tumor nodule, which could be processed in a “virtual biopsy”. Recently, diagnostic research has presented the clinical benefit of artificial intelligence (AI) in the use of deep-learning strategies for digital diagnosis of poorly differentiated or microvascular-infiltrated tumors. In addition, evaluation of TACE response is analyzed as a possibility to estimate LT survival. The aim of this review is to provide an overview of recent advances in HCC diagnosis and to classify the clinical relevance of these diagnostic and technical advances. Secondly, we discuss how these advances could affect the organ allocation process.
尽管治疗理念有所改进，肝细胞癌（HCC）患者的生存期仍然有限。对于符合条件的患者，肝移植（LT）是最佳治疗方案。这一疗法尤为重要，因为它不仅能切除癌症，还能治愈潜在的结构性肝病。然而，由于供体器官持续短缺，肝移植后的肿瘤学预后对于公平的器官分配至关重要。在一定肿瘤范围内，患者可在器官等待名单中获得加分。通常，大血管侵犯和肝外肿瘤表现被视为肝移植的禁忌症，因为这些患者的生存率极低。近年来，微血管侵犯和低分化肿瘤也被证明是不利因素。大多数肝细胞癌肝移植的选择标准仍基于非常简单的影像学标准，如大小和数量，而未利用肿瘤结节固有的额外影像特征，这些特征可通过“虚拟活检”进行处理。最近，诊断研究展示了人工智能（AI）在低分化或微血管浸润肿瘤的数字诊断中应用深度学习策略的临床益处。此外，经动脉化疗栓塞（TACE）反应的评估也被分析为预测肝移植生存率的一种可能方法。本综述旨在概述肝细胞癌诊断的最新进展，并对这些诊断和技术进步的临床相关性进行分类。其次，我们讨论这些进展如何影响器官分配过程。
肿瘤(癌症)患者之家