Immunotherapy of recurrence and metastasis after liver transplantation for liver cancer
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摘要: 原发性肝癌(肝癌)是我国肝移植的主要适应证之一,但肝癌肝移植受者术后5年生存率不足50%,术后复发转移是影响受者长期生存的主要原因。目前,以程序性细胞死亡蛋白1(PD-1)/程序性细胞死亡蛋白配体1(PD-L1)免疫检查点抑制剂为代表的免疫治疗在中晚期肝癌治疗中取得显著疗效,但其在肝癌肝移植术后肿瘤复发转移受者中能否应用尚有较多争议,主要原因在于其在发挥作用的同时可能会引起急性排斥反应。本文总结了免疫治疗在肝癌肝移植术后复发转移受者中的应用进展,以期通过免疫治疗改善肝癌肝移植受者的生存率。
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关键词:
- 原发性肝癌 /
- 肝移植 /
- 复发转移 /
- 程序性细胞死亡蛋白1(PD-1) /
- 免疫治疗 /
- 免疫检查点抑制剂(ICI) /
- 急性排斥反应 /
- 免疫逃逸 /
- 纳武单抗 /
- 帕博利珠单抗
Abstract: Primary liver cancer (liver cancer) is one of the main indications of liver transplantation in China. Nevertheless, the 5-year survival rate of liver transplant recipients is lower than 50%. Recurrence and metastasis after operation are the main causes affecting the long-term survival of the recipients. At present, immunotherapy, represented by programmed cell death protein 1(PD-1)/programmed cell death protein-ligand 1(PD-L1) immune checkpoint inhibitor, has achieved remarkable clinical efficacy in the treatment of middle-stage and advanced liver cancer. However, whether it can be applied in recipients with recurrence and metastasis after liver transplantation for liver cancer remains controversial. The main reason is that it may cause acute rejection at the same time. In this article, the research progresses on the application of immunotherapy in recipients with recurrence and metastasis after liver transplantation for liver cancer were reviewed, aiming to improve the survival rate of recipients undergoing liver transplantation forliver cancer. -
表 1 肝癌肝移植术后复发转移受者免疫治疗的临床特征
Table 1. Clinical characteristics of immunotherapy for recipients with recurrence and metastasis after liver transplantationfor liver cancer
研究者 受者年龄(岁) 性别 术后时间(年) 免疫抑制剂 免疫治疗 结局 排斥反应 生存时间(月) 汪国营, 等[22] 48 男 1.0 Tac+西罗莫司 帕博利珠单抗 疾病进展 有 8.0① Varkaris A, et al[23] 70 男 8.0 Tac 帕博利珠单抗 疾病进展 无 3.0 Gassmann D, et al[24] 53 女 2.0 依维莫司+MMF 纳武单抗 器官衰竭 有 0.8 Friend BD, et al[25] 14 男 3.0 Tac 纳武单抗 器官衰竭 有 2.0 20 男 4.0 Tac 纳武单抗 器官衰竭 有 1.0 Amjad W, et al[26] 62 女 1.3 Tac+MMF 纳武单抗 完全缓解 无 24.0① Rammohan A, et al[27] 57 男 3.3 Tac+MMF+糖皮质激素 帕博利珠单抗 完全缓解 无 10.0① De Toni EN, et al[28] 41 男 1.0 Tac 纳武单抗 分离反应后疾病进展 无 10.0 DeLeon TT, et al[29] 56 男 2.7 Tac 纳武单抗 疾病进展 无 1.2 55 男 7.8 Tac+MMF 纳武单抗 疾病进展 无 1.1 34 女 3.7 Tac 纳武单抗 疾病进展 无 1.3 63 男 1.2 Tac 纳武单抗 未知 无 0.3 68 男 1.1 Tac 纳武单抗 未知 有 0.9 注:①为文章投稿时受者仍在随访。 表 2 肝癌肝移植术后新发其他肿瘤受者免疫治疗的临床特征
Table 2. Clinical characteristics of immunotherapy for recipients with other de novo tumors after liver transplantationfor liver cancer
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