New Scenarios in Liver Transplantation for Hepatocellular Carcinoma
Liver International,
Journal Year:
2024,
Volume and Issue:
unknown
Published: Nov. 4, 2024
ABSTRACT
Background
and
Aims
Despite
liver
transplantation
(LT)
is
considered
the
optimal
treatment
for
hepatocellular
carcinoma
(HCC),
particularly
in
patients
with
impaired
function,
shortage
of
donors
has
forced
application
very
restrictive
criteria
selecting
ideal
candidates
whom
LT
can
offer
best
outcome.
With
evolving
landscape
due
to
advent
direct‐acting
antivirals
(DAAs)
steady
increase
donors,
major
efforts
have
been
made
expand
transplant
eligibility
HCC.
In
addition,
emergence
immune
checkpoint
inhibitors
(ICIs)
HCC,
demonstrated
efficacy
earlier
stages,
revolutionized
therapeutic
approach
these
patients,
their
integration
setting
challenging.
Management
immunological
compromise
from
ICIs,
including
wash‐out
period
before
post‐LT
immunosuppression
adjustments,
crucial
balance
risk
graft
rejection
against
HCC
recurrence.
Additionally,
effects
increased
on
non‐hepatic
complications
must
be
understood
prevent
them
becoming
obstacles
long‐term
OS.
Methods
Results
this
review,
we
will
evaluate
emerging
evidence
its
implications
future
Addressing
novel
challenges
opportunities,
while
integrating
current
clinical
predictive
algorithms,
would
ensure
a
fair
between
individual
patient
needs
overall
population
benefit
system.
Language: Английский
Systemic Treatment of Recurrent Hepatocellular Carcinoma after Liver Transplantation: A Multicenter Trial
Cancers,
Journal Year:
2024,
Volume and Issue:
16(13), P. 2442 - 2442
Published: July 3, 2024
The
tyrosine
kinase
inhibitors
(TKIs)
sorafenib
and
lenvatinib
represent
the
first-line
systemic
therapy
of
choice
for
patients
with
hepatocellular
carcinoma
(HCC)
recurrence
after
liver
transplantation
(LT).
Under
lenvatinib,
HCC
have
shown
increasingly
improved
overall
survival
in
clinical
studies
over
years.
In
contrast,
data
on
LT
under
TKIs
are
scarce
limited
to
small
retrospective
series.
this
retrospective,
multicenter
study,
we
investigated
efficacy
TKI
influence
immunosuppression
LT.
Language: Английский
The Role of Lymphadenectomy in the Surgical Treatment of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Cancers,
Journal Year:
2024,
Volume and Issue:
16(24), P. 4166 - 4166
Published: Dec. 13, 2024
Background:
Lymphadenectomy
in
the
operative
management
of
hepatocellular
carcinoma
(HCC)
remains
controversial,
with
no
recommendation
for
routine
practice.
Our
study
aimed
to
assess
effects
lymphadenectomy
addition
hepatic
resection
(HR)
compared
HR
alone
adults
HCC.
Methods:
This
systematic
review
was
conducted
according
PRISMA
guidelines
until
March
2023,
searching
and
selecting
relevant
literature
comparing
lymph
node
dissection
or
sampling,
combined
HR,
removal.
Critical
appraisal
included
studies
performed
using
ROBINS-I
tool.
Fixed-
random-effect
meta-analysis
models
were
carried
out,
inter-studies
assessed
heterogeneity.
Results:
Fourteen
selected
during
screening
process.
Data
from
eight
containing
32,041
HCC
patients
quantitative
synthesis.
In
total,
12,694
underwent
(LND),
either
selectively
preoperatively
diagnosed
intraoperatively
suspected
metastasis
(LNM)
unselectively
(i.e.,
regardless
LNM).
According
LN
status,
1-,
3-
5-year
mortality
rates
higher
LNM
group
respect
both
clinically
negative
(OR
3.25,
95%
CI
2.52–4.21;
p
<
0.001;
OR
3.79,
2.74–5.24;
3.92,
2.61–5.88;
0.001)
proven
LN0
1.75,
1.0–3.04;
=
0.05;
2.88,
1.79–4.63;
2.54,
1.33–4.84;
0.001).
Moreover,
summary
estimates
two
controlled
trials
showed
significant
difference
overall
survival
between
LND
groups
those
without
patients.
Conclusions:
Lymph
does
not
appear
improve
survival,
available
literature;
thus,
this
support
its
adoption
as
part
standard
liver
A
case-by-case
decision
advisable.
Language: Английский