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Academician Zheng Shusen: “Hangzhou Standard” of liver cancer and liver transplantation

When the liver disease develops to life -threatening life, through the method of surgery, remove the diseased liver that has lost function, transplant a healthy liver with vitality into the patient and regain life. This process is liver transplantation. liver”. In recent years, China’s liver transplantation has shown a high -speed growth trend and has become the world’s second largest liver transplantation country.

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Academician Zheng Shusen, Vice President of the Chinese Medical Association and the Academician of the Chinese Academy of Engineering, said at the Academician Forum of the 2022 China Oncology Conference that among the Chinese adult liver transplant, the proportion of liver cancer is as high as 42%. Essence

◎ Academician Zheng Shusen. / 2022 The organizer of the China Oncology Conference Conference Confer

Patients with liver cancer can benefit from liver transplantation

Liver transplantation has a triple advantage of complete resection of tumors, healing liver hardening, and removing HBV. Academician Zheng Shusen said that according to the BCLC installment, liver transplantation can achieve better results in early, middle and late liver cancer. Take early liver cancer as an example. At present, the early liver cancer is still surgically removed, or the radio frequency ablation is mainly, with an average survival time of more than 6 years. However, if the patient’s liver function is poor, liver transplantation needs to be performed. Surgical treatment or radio frequency ablation.

“I have a patient, which belongs to small liver cancer, but is accompanied by severe liver cirrhosis and a large amount of ascites. If surgical tumor resection, the patient’s bleeding during surgery will be very large. Finally, the liver transplantation will be selected. Surviving later, more than 16 years. “

◎ 2022 China Oncology Conference site. / 2022 The organizer of the China Oncology Conference Conference Confer

Academician Zheng Shusen introduced that the mid -term liver cancer can implement TACE local/resection/targeted immunotherapy under the condition of low tumor load and good liver function. However, the tumor is> 5 cm, and there are multiple tumors distributed. Under the poor liver function, liver transplantation can be considered. Such high -load tumors (large tumors) scores have higher liver transplant survival benefits.

Liver cancer in the middle and late stages, that is, liver cancer during the progress period: patients with large vascular violations or patients with liver metastases can first receive non -surgical treatment based on local treatment and systematic treatment, and liver transplantation after conversion treatment.

“Whether patients with liver cancer can benefit in liver transplantation are controversial. I have a patient, a 42 -year -old woman, diagnosed with right liver permeability of nodular liver cancer, and door vein and right cancer embolism. Hempidth dehomatology (medium-low-differentiated liver cell carcinoma), AFP drops from 773ng/ml before surgery to 4.9ng/ml. In October 2008, hepatoma cancer recurrence (diameter 1.8cm), AFP rose to 26ng/ml, two TACE/RFA and Sorafeni were treated, AFP dropped to 3.6ng/ml, liver transplantation was performed in December of the same year, and now no tumor survival has been survived for 14 years. “Academician Zheng Shusen said.

Tumor biology characteristics are the key to affecting the prognosis of liver cancer transplantation

Since the introduction of the Milan standard in 1996, the academic community has proposed many selection standards for liver cancer and liver transplantation, and the long -term effects after transplantation have also continued to improve. %. However, the large number of liver cancer people in my country, if referring to the Milan standard, it means that many patients with liver cancer have missed the opportunity to transplant liver transplantation.

Therefore, Academician Zheng Shusen’s team proposed the “Hangzhou standard” for liver cancer transplantation. “We expanded liver cancer liver transplantation to 8 cm without large vascular invasion; AFP level ≤ 400ng/ml; tissue grading is medium or highly differentiated, and liver transplantation can be implemented.” Academician Zheng Shusen said that the “Hangzhou standard” in 2020 Then expand, change to the door vein branch cancer thrombus; cumulative tumor diameter ≤ 8 cm; or cumulative tumor diameter> 8 cm, AFP level ≤1000ng/ml, tumor metabolism: patients with liver cancer in SUVMAX <5 can perform liver transplantation, "currently patients are currently patients 3 years of tumor -free survival can reach 67%. "

Throughout the standards of liver cancer transplantation in the world, Hangzhou standards combine tumor morphological and biological characteristics. “Now it can be said that the size of tumors in liver cancer liver transplantation is no longer the key.”

◎ Figure: 123RF

What about these patients who have surpassed the “Hangzhou Standard”? Academician Zheng Shusen proposed that such patients can first have been treated with downgraded treatment. For example, the target exemptions to the local treatment before the deadline, and then liver transplantation is performed.

In addition, liver transplantation can be moved forward, especially for patients with liver metastasis with liver metastasis of colon cancer/pancreatic cancer. The liver function is not good. You can first perform liver transplantation and then comprehensive anti -tumor treatment, which can achieve better results.

“I am a 55 -year -old patients with sigmal colon cancer, accompanied by multiple metastases in the liver, and colonoscopy in biochemistry. The pathogenic glandular cancer, TB 372umol/L, CEA 3216ng/ml, CA 19910140U/ml. After liver transplantation, one after surgery The month CEA dropped to normal, and the 6 course of treatment of MFOLFOX scheme chemotherapy. There was no significant signs of tumor recurrence in imaging.

Among the patients with intrahepatic chip tube cell carcinoma, the experience of the University of Hong Kong showed that the liver transplantation of the early hepatic bile duct cell carcinoma was better than surgical resection. In addition, neoodramid chemotherapy before the liver cell carcinoma can improve the survival rate before the liver transplantation of the liver.

What should I do if tumor recurrence is recurred after liver cancer surgery before liver cancer surgery before liver cancer is effectively improved by the pre -surgery and postoperative comprehensive treatment. At present, tumor recurrence after liver cancer is mainly concentrated in the liver, lungs, and bones.

Academician Zheng Shusen suggested to prevent chemotherapy/targeted drugs. First of all, comprehensive treatment such as surgical resection and combined targeting. For the minimization plan of an immunosuppressure agent based on MTOR, the mid -level survival time can still reach 20.9 months after the recurrence of the tumor.

◎ Figure: 123RF

Why not give priority to PD-1 immunotherapy? “It is mainly due to a large proportion of acute rejection, and doctors need to choose more carefully.” Academician Zheng Shusen reminded.

For the current serious shortage of organs, causing liver cancer patients in the transplant waiting list due to the long waiting time and the progress of tumor progress from the waiting list, Academician Zheng Shusen said that for the source of the liver, age is no longer a limited factor, 60 60, 60 The liver of the age-80-year-old can also be used. In addition, the split -type liver transplantation and full liver transplantation are not effective. “Edge -based liver supply and split -off liver transplantation are an effective means to alleviate the shortage of liver supply.”

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