Chinese expert consensus on prevention and treatment of recurrence and metastasis after liver transplantation for hepatocellular carcinoma (2025 edition)

doi:10.3877/cma.j.issn.1674-3903.2025.06.002

Abstract

Abstract:

Recurrence and metastasis after liver transplantation for hepatocellular carcinoma (HCC) remain the major challenge affecting the long-term survival of patients. To address this, the Branch of Organ Transplantation of Chinese Medical Association, in conjunction with experts from relevant fields, formulated the Chinese Expert Consensus on Prevention and Treatment of Recurrence and Metastasis after Liver Transplantation for Hepatocellular Carcinoma (2025 Edition) based on evidence-based medicine and GRADE system following in-depth deliberation. The consensus aims to provide scientific guidance for clinical practice of liver transplantation in China. It emphasizes the importance of personalized treatment strategies, proposes optimizing immunosuppressive strategies and various adjuvant therapies to reduce recurrence risk, and compares the indications and potential risks of surgical, locoregional, and systemic therapies. It also systematically summarizes the identification of high-risk groups, predictive factors, novel biomarkers, prognostic models, prevention strategies, monitoring protocols, diagnostic methods, and treatment pathways for recurrence and metastasis after liver transplantation for HCC, with the goal of improving postoperative survival rate and quality of life of patients.

Key words: Hepatocellular carcinoma, Liver transplantation, Tumor recurrence and metastasis, Immunosuppression, Adjuvant therapy

Branch of Organ Transplantation of Chinese Medical Association. Chinese expert consensus on prevention and treatment of recurrence and metastasis after liver transplantation for hepatocellular carcinoma (2025 edition)[J]. Chinese Journal of Transplantation(Electronic Edition), doi: 10.3877/cma.j.issn.1674-3903.2025.06.002.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhyzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3903.2025.06.002

Figures/Tables 2

References 140

1	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1): 47-53.
2	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2024年版)[J]. 中华外科杂志，2024, 62(6)：477-503.
3	Vogel A, Meyer T, Sapisochin G, et al. Hepatocellular carcinoma[J]. Lancet, 2022, 400(10360): 1345-1362.
4	Moeckli B, Majno P, Orci LA, et al. Liver transplantation selection and allocation criteria for hepatocellular carcinoma: a European perspective[J]. Semin Liver Dis, 2021, 41(2): 172-181.
5	Sposito C, Cucchetti A, Mazzaferro V. Assessing competing risks for death following liver transplantation for hepatocellular carcinoma[J]. Dig Dis Sci, 2019, 64(4): 1001-1007.
6	Filgueira NA. Hepatocellular carcinoma recurrence after liver transplantation: risk factors, screening and clinical presentation[J]. World J Hepatol, 2019, 11(3): 261-272.
7	Bodzin AS, Lunsford KE, Markovic D, et al. Predicting mortality in patients developing recurrent hepatocellular carcinoma after liver transplantation: impact of treatment modality and recurrence characteristics[J]. Ann Surg, 2017, 266(1): 118-125.
8	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ, 2008, 336(7650): 924-926.
9	樊嘉，史颖弘，田孟鑫. 肝癌肝移植术后肿瘤复发的防治策略[J]. 中华消化外科杂志，2019, 18(1): 20-23.
10	Zhou Z, Liu Q, Liu J, et al. Research progress of protein induced by vitamin K absence or antagonist II in liver transplantation for hepatocellular carcinoma[J]. Heliyon, 2024, 10(9): e30622.
11	Shan Y, Huang L, Xia Q. Salvage liver transplantation leads to poorer outcome in hepatocellular carcinoma compared with primary liver transplantation[J]. Sci Rep, 2017, 7: 44652.
12	国家科技部传染病防治重大专项课题《病毒性肝炎相关肝癌外科综合治疗的个体化和新策略研究》专家组．肝细胞癌肝切除术后复发预防和治疗中国专家共识(2020版)[J]. 中国实用外科杂志，2021, 41(1)：20-30.
13	Qu WF, Tian MX, Lu HW, et al. Development of a deep pathomics score for predicting hepatocellular carcinoma recurrence after liver transplantation[J]. Hepatol Int, 2023, 17(4): 927-941.
14	Wang J, Bao J, Wang R, et al. The predictive value of the modified AFP model for liver transplantation outcomes in multinodular hepatocellular carcinoma patients[J]. World J Surg Oncol, 2023, 21(1): 104.
15	Wang K, Dong L, Lu Q, et al. Incorporation of protein induced by vitamin K absence or antagonist-II into transplant criteria expands beneficiaries of liver transplantation for hepatocellular carcinoma: a multicenter retrospective cohort study in China[J]. Int J Surg, 2023, 109(12): 4135-4144.
16	Fan J, Yang GS, Fu ZR, et al. Liver transplantation outcomes in 1，078 hepatocellular carcinoma patients: a multi-center experience in Shanghai, China[J]. J Cancer Res Clin Oncol, 2009, 135(10): 1403-1412.
17	Xu X, Lu D, Ling Q, et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria[J]. Gut, 2016, 65(6): 1035-1041.
18	Li J, Yan LN, Yang J, et al. Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients[J]. World J Gastroenterol, 2009, 15(33): 4170-4176.
19	邵卓，杨广顺，杨宁，等. 三亚共识在原发性肝癌肝移植治疗中的运用[J]. 中国实用外科杂志，2008, 28(6): 466-469.
20	樊嘉，周俭，徐泱. "上海标准"在肝癌肝移植适应证中应用13年的回顾分析[J]. 中华器官移植杂志，2013, 34(9): 521-523.
21	徐骁，杨家印，钟林，等. 肝癌肝移植"杭州标准"的多中心应用研究——1163例报道[J]. 中华器官移植杂志，2013, 34(9): 524-527.
22	Mehta N, Frenette C, Tabrizian P, et al. Downstaging outcomes for hepatocellular carcinoma: results from the multicenter evaluation of reduction in tumor size before liver transplantation (MERITS-LT) consortium[J]. Gastroenterology, 2021, 161(5): 1502-1512.
23	Yao FY, Mehta N, Flemming J, et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria[J]. Hepatology, 2015, 61(6): 1968-1977.
24	Merani S, Majno P, Kneteman NM, et al. The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma[J]. J Hepatol, 2011, 55(4): 814-819.
25	Samuel D, Coilly A. Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation[J]. BMC Med, 2018, 16(1): 113.
26	Giard JM, Mehta N, Dodge JL, et al. Alpha-fetoprotein slope >7.5 ng/mL per month predicts microvascular invasion and tumor recurrence after liver transplantation for hepatocellular carcinoma[J]. Transplantation, 2018, 102(5): 816-822.
27	Agopian VG, Harlander-Locke MP, Ruiz RM, et al. Impact of pretransplant bridging locoregional therapy for patients with hepatocellular carcinoma within Milan criteria undergoing liver transplantation: analysis of 3 601 patients from the US multicenter HCC transplant consortium[J]. Ann Surg, 2017, 266(3): 525-535.
28	Ye Q, Ling S, Zheng S, et al. Liquid biopsy in hepatocellular carcinoma: circulating tumor cells and circulating tumor DNA[J]. Mol Cancer, 2019, 18(1): 114.
29	Chen Z, Lin X, Chen C, et al. Analysis of preoperative circulating tumor cells for recurrence in patients with hepatocellular carcinoma after liver transplantation[J]. Ann Transl Med, 2020, 8(17): 1067.
30	Wang PX, Xu Y, Sun YF, et al. Detection of circulating tumour cells enables early recurrence prediction in hepatocellular carcinoma patients undergoing liver transplantation[J]. Liver Int, 2021, 41(3): 562-573.
31	Huang A, Guo DZ, Zhang X, et al. Serial circulating tumor DNA profiling predicts tumor recurrence after liver transplantation for liver cancer[J]. Hepatol Int, 2024, 18(1): 254-264.
32	Bai DS, Dai Z, Zhou J, et al. Capn4 overexpression underlies tumor invasion and metastasis after liver transplantation for hepatocellular carcinoma[J]. Hepatology, 2009, 49(2): 460-470.
33	Shi YH, Ding WX, Zhou J, et al. Expression of X-linked inhibitor-of-apoptosis protein in hepatocellular carcinoma promotes metastasis and tumor recurrence[J]. Hepatology, 2008, 48(2): 497-507.
34	Huang Y, Yang X, Zhao F, et al. Overexpression of Dickkopf-1 predicts poor prognosis for patients with hepatocellular carcinoma after orthotopic liver transplantation by promoting cancer metastasis and recurrence[J]. Med Oncol, 2014, 31(7): 966.
35	Gao Q, Zhou J, Wang XY, et al. Infiltrating memory/senescent T cell ratio predicts extrahepatic metastasis of hepatocellular carcinoma[J]. Ann Surg Oncol, 2012, 19(2): 455-466.
36	Sun R, Zhang L, Yang Z, et al. Liver transplantation for hepatocellular carcinoma: a prognostic model incorporating pretransplant inflammatory cytokines[J]. Cytokine, 2022, 153: 155847.
37	Agopian VG, Harlander-Locke M, Zarrinpar A, et al. A novel prognostic nomogram accurately predicts hepatocellular carcinoma recurrence after liver transplantation: analysis of 865 consecutive liver transplant recipients[J]. J Am Coll Surg, 2015, 220(4): 416-427.
38	Mazzaferro V, Sposito C, Zhou J, et al. Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma[J]. Gastroenterology, 2018, 154(1): 128-139.
39	Ling S, Yu J, Zhan Q, et al. Multi-omic analysis reveals a CAF-stemness-governed classification in HCC liver transplant recipients beyond the Milan criteria[J]. Nat Commun, 2025, 16(1): 4392.
40	Tran BV, Moris D, Markovic D, et al. Development and validation of a recurrent liver cancer prediction score (RELAPSE) following liver transplantation in patients with hepatocellular carcinoma: analysis of the US multicenter HCC transplant consortium[J]. Liver Transpl, 2023, 29(7): 683-697.
41	Firl DJ, Sasaki K, Agopian VG, et al. Charting the path forward for risk prediction in liver transplant for hepatocellular carcinoma: international validation of HALTHCC among 4，089 patients[J]. Hepatology, 2020, 71(2): 569-582.
42	Goldberg D, Mantero A, Newcomb C, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma using the LiTES-HCC score[J]. J Hepatol, 2021, 74(6): 1398-1406.
43	Liu Z, Liu Y, Zhang W, et al. Deep learning for prediction of hepatocellular carcinoma recurrence after resection or liver transplantation: a discovery and validation study[J]. Hepatol Int, 2022, 16(3): 577-589.
44	He X, Xu S, Tang L, et al. Insights into the history and tendency of liver transplantation for liver cancer: a bibliometric-based visual analysis[J]. Int J Surg, 2024, 110(1): 406-418.
45	Cheng JW, Shi YH, Fan J, et al. An immune function assay predicts post-transplant recurrence in patients with hepatocellular carcinoma[J]. J Cancer Res Clin Oncol, 2011, 137(10): 1445-1453.
46	Zhu JQ, Zhou L, Kou JT, et al. Individualized management of immunosuppressants in liver transplant recipients by using a novel immune score system[J]. Am J Transl Res, 2024, 16(4): 1353-1365.
47	Imaoka Y, Ohira M, Sato S, et al. Impact of a liver immune status index among living liver transplant recipients with hepatocellular carcinoma[J]. JMA J, 2024, 7(2): 232-239.
48	Rodríguez-Perálvarez M, Tsochatzis E, Naveas MC, et al. Reduced exposure to calcineurin inhibitors early after liver transplantation prevents recurrence of hepatocellular carcinoma[J]. J Hepatol, 2013, 59(6): 1193-1199.
49	Hu AB, Wu LW, Tai Q, et al. Safety and efficacy of four steroid-minimization protocols in liver transplant recipients: 3-year follow-up in a single center[J]. J Dig Dis, 2013, 14(1): 38-44.
50	Wei Q, Gao F, Zhuang R, et al. A national report from China Liver Transplant Registry: steroid avoidance after liver transplantation for hepatocellular carcinoma[J]. Chin J Cancer Res, 2017, 29(5): 426-437.
51	Zahn A, Müeller F, Hinz U, et al. Mycophenolate mofetil combination therapy improves survival after liver transplantation. A single-center retrospective analysis[J]. Ann Transplant, 2013, 18: 525-532.
52	Duvoux C, Toso C. mTOR inhibitor therapy: Does it prevent HCC recurrence after liver transplantation？[J]. Transplant Rev (Orlando), 2015, 29(3): 168-174.
53	Zhou J, Fan J, Wang Z, et al. Conversion to sirolimus immunosuppression in liver transplantation recipients with hepatocellular carcinoma: Report of an initial experience[J]. World J Gastroenterol, 2006, 12(19): 3114-3118.
54	Zhou J, Wang Z, Wu ZQ, et al. Sirolimus-based immunosuppression therapy in liver transplantation for patients with hepatocellular carcinoma exceeding the Milan criteria[J]. Transplant Proc, 2008, 40(10): 3548-3553.
55	Ling S, Feng T, Zhan Q, et al. Sirolimus-based immunosuppression improves outcomes in liver transplantation recipients with hepatocellular carcinoma beyond the Hangzhou criteria [J]. Ann Transl Med, 2020, 8(4): 80.
56	Schnitzbauer AA, Filmann N, Adam R, et al. mTOR inhibition is most beneficial after liver transplantation for hepatocellular carcinoma in patients with active tumors [J]. Ann Surg, 2020, 272(5): 855-862.
57	Zhang G, Duan B, Li G. mTORi-based immunosuppression reduces HCC recurrence at the expense of increased adverse side effects: a systematic review and meta-analysis[J]. Clin Transplant, 2022, 36(12): e14823.
58	Yan X, Huang S, Yang Y, et al. Sirolimus or everolimus improves survival after liver transplantation for hepatocellular carcinoma: a systematic review and meta-analysis[J]. Liver Transpl, 2022, 28(6): 1063-1077.
59	Lee SG, Jeng LB, Saliba F, et al. Efficacy and safety of everolimus with reduced tacrolimus in liver transplant recipients: 24-month results from the pooled analysis of 2 randomized controlled trials[J]. Transplantation, 2021, 105(7): 1564-1575.
60	Saliba F, De Simone P, Nevens F, et al. Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study[J]. Am J Transplant, 2013, 13(7): 1734-1745.
61	Lin HS, Wan RH, Gao LH, et al. Adjuvant chemotherapy after liver transplantation for hepatocellular carcinoma: a systematic review and a meta-analysis[J]. Hepatobiliary Pancreat Dis Int, 2015, 14(3): 236-245.
62	Zhu HK, Mou HB, Wang ZY, et al. Adjuvant chemotherapy improves post-transplant outcome in patients with hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2025, 24(5)：491-499.
63	Han B, Ding H, Zhao S, et al. Potential role of adjuvant lenvatinib in improving disease-free survival for patients with high-risk hepatitis B virus-related hepatocellular carcinoma following liver transplantation: a retrospective, case control study[J]. Front Oncol, 2020, 10: 562103.
64	Teng CL, Hwang WL, Chen YJ, et al. Sorafenib for hepatocellular carcinoma patients beyond Milan criteria after orthotopic liver transplantation: a case control study[J]. World J Surg Oncol, 2012, 10: 41.
65	Guo DZ, Cheng JW, Yan JY, et al. Efficacy and safety of lenvatinib for preventing tumor recurrence after liver transplantation in hepatocellular carcinoma beyond the Milan criteria [J]. Ann Transl Med, 2022, 10(20): 1091.
66	Xu J, Shen ZY, Chen XG, et al. A randomized controlled trial of Licartin for preventing hepatoma recurrence after liver transplantation[J]. Hepatology, 2007, 45(2): 269-276.
67	Lei JY, Yan LN, Zhu JQ, et al. Hepatocellular carcinoma patients may benefit from postoperative huaier aqueous extract after liver transplantation[J]. Transplant Proc, 2015, 47(10): 2920-2924.
68	Zhou L, Pan LC, Zheng YG, et al. Novel strategy of sirolimus plus thymalfasin and huaier granule on tumor recurrence of hepatocellular carcinoma beyond the UCSF criteria following liver transplantation: a single center experience[J]. Oncol Lett, 2018, 16(4): 4407-4417.
69	Ohira M, Hotta R, Tanaka Y, et al. Pilot study to determine the safety and feasibility of deceased donor liver natural killer cell infusion to liver transplant recipients with hepatocellular carcinoma[J]. Cancer Immunol Immunother, 2022, 71(3): 589-599.
70	Tanimine N, Ohira M, Kurita E, et al. Impact of KIR-HLA genotype on natural-killer-cell-based immunotherapy for preventing hepatocellular carcinoma after living-donor liver transplantation[J]. Cancers (Basel), 2024, 16(3)：533.
71	Wassmer CH, El Hajji S, Papazarkadas X, et al. Immunotherapy and liver transplantation: a narrative review of basic and clinical data[J]. Cancers (Basel), 2023, 15(18)：4574.
72	Singal AG, Yarchoan M, Yopp A, et al. Neoadjuvant and adjuvant systemic therapy in HCC: Current status and the future[J]. Hepatol Commun, 2024, 8(6) ：e0430.
73	Demetris AJ, Todo S, Van Thiel DH, et al. Evolution of hepatitis B virus liver disease after hepatic replacement. Practical and theoretical considerations[J]. Am J Pathol, 1990, 137(3): 667-676.
74	Cholongitas E, Goulis J, Akriviadis E, et al. Hepatitis B immunoglobulin and/or nucleos(t)ide analogues for prophylaxis against hepatitis b virus recurrence after liver transplantation: a systematic review[J]. Liver Transpl, 2011, 17(10): 1176-1190.
75	中华医学会肝病学分会，中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华临床感染病杂志，2022，15(6)：401-427.
76	Lee DD, Sapisochin G, Mehta N, et al. Surveillance for HCC after liver transplantation: increased monitoring may yield aggressive treatment options and improved postrecurrence survival[J]. Transplantation, 2020, 104(10): 2105-2112.
77	Clavien PA, Lesurtel M, Bossuyt PM, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report [J]. Lancet Oncol, 2012, 13(1): e11-e22.
78	Rajendran L, Ivanics T, Claasen MP, et al. The management of post-transplantation recurrence of hepatocellular carcinoma[J]. Clin Mol Hepatol, 2022, 28(1): 1-16.
79	Sapisochin G, Goldaracena N, Astete S, et al. Benefit of treating hepatocellular carcinoma recurrence after liver transplantation and analysis of prognostic factors for survival in a large Euro-American series[J]. Ann Surg Oncol, 2015, 22(7): 2286-2294.
80	中国医师协会器官移植医师分会，中华医学会器官移植学分会肝移植学组. 中国肝癌肝移植临床实践指南(2021版)[J/OL]. 中华移植杂志：电子版，2021, 15(6): 321-328.
81	Liu D, Chan AC, Fong DY, et al. Evidence-based surveillance imaging schedule after liver transplantation for hepatocellular carcinoma recurrence[J]. Transplantation, 2017, 101(1): 107-111.
82	Kodali S, Kulik L, D′Allessio A, et al. The 2024 ILTS-ILCA consensus recommendations for liver transplantation for HCC and intrahepatic cholangiocarcinoma [J]. Liver Transpl, 2025, 31(6): 815-831.
83	Zhang Q, Shang L, Zang Y, et al. α-fetoprotein is a potential survival predictor in hepatocellular carcinoma patients with hepatitis B selected for liver transplantation[J]. Eur J Gastroenterol Hepatol, 2014, 26(5): 544-552.
84	Lai Q, Ito T, Iesari S, et al. Role of protein induced by vitamin-K absence-II in transplanted patients with HCC not producing alpha-fetoprotein[J]. Liver Transpl，2024，30(5): 472-483.
85	Li L, Zhang WH, Meng FP, et al. Gastric metastasis of hepatocellular carcinoma with gastrointestinal bleeding after liver transplant: a case report[J]. Transplant Proc, 2015, 47(8): 2544-2547.
86	Han H, Liu R, Wang WP, et al. Postoperative haemodynamic changes in transplanted liver: Long-term follow-up with ultrasonography[J]. J Int Med Res, 2014, 42(3): 849-856.
87	Chen YS, Lim WX, Lin AN, et al. Clinical impact of gadoxetic acid-enhanced magnetic resonance imaging on living donor liver transplant[J]. Transplant Proc, 2022, 54(2): 386-390.
88	Wang K, Jin X, Zhou J, et al. Differences in the diagnosis and treatment of patients with early-stage hepatocellular liver cancer by multi-row spiral CTMDCT and Gd-EOB-DTPA-enhanced MRI[J]. Altern Ther Health Med, 2024, 30(1): 31-35.
89	Wang Y, Zhu GQ, Yang R, et al. Deciphering intratumoral heterogeneity of hepatocellular carcinoma with microvascular invasion with radiogenomic analysis[J]. J Transl Med, 2023, 21(1): 734.
90	Bodzin AS, Lunsford KE, Markovic D, et al. Predicting mortality in patients developing recurrent hepatocellular carcinoma after liver transplantation: Impact of treatment modality and recurrence characteristics[J]. Ann Surg, 2017, 266(1) ：118-125.
91	Ningarhari M, Lassailly G, Dharancy S, et al. Recurrence of hepatocellular carcinoma after liver transplantation: the blind spot of HCC management[J]. United European Gastroenterol J, 2025，13(7)：1069-1076.
92	Lee CH, Brubaker LM, Gerber DA, et al. MRI findings of recurrent hepatocellular carcinoma after liver transplantation: preliminary results[J]. J Magn Reson Imaging, 2011, 33(6): 1399-1405.
93	王全师，王欣璐，李华，等. 肝癌患者肝移植术前后正电子发射计算机体层摄影-CT检查的临床应用价值[J]. 中华放射学杂志，2005, 39(11): 1171-1175.
94	Zhang Y, Shi H, Cheng D, et al. Added value of SPECT/spiral CT versus SPECT in diagnosing solitary spinal lesions in patients with extraskeletal malignancies[J]. Nucl Med Commun, 2013, 34(5): 451-458.
95	Zucchetta P, Lacognata C, Girardi F, et al. [18F]FDG PET/MRI in the follow-up of hepatocellular carcinoma after liver transplantation[J]. Nucl Med Commun, 2022, 43(3): 359-367.
96	Chen J, Shen T, Li J, et al. Clinical practice guideline on liver transplantation for hepatocellular carcinoma in China (2021 edition)[J]. Chin Med J (Engl), 2022, 135(24): 2911-2913.
97	Agarwal PD, Lucey MR. Management of hepatocellular carcinoma recurrence after liver transplantation[J]. Ann Hepatol, 2022, 27(1): 100654.
98	Au KP, Chok KSH. Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: a proposed management algorithm[J]. World J Gastroenterol, 2018, 24(45): 5081-5094.
99	Welker MW, Bechstein WO, Zeuzem S, et al. Recurrent hepatocellular carcinoma after liver transplantation - an emerging clinical challenge[J]. Transpl Int, 2013, 26(2): 109-118.
100	贺轶锋，宋康，杨国欢. 符合"复旦标准"的肝癌肝移植受者复发后生存状况及诊治策略 [J]. 中华器官移植杂志，2021, 42(2)：82-86.
101	Sapisochin G, Goldaracena N, Astete S, et al. Benefit of treating hepatocellular carcinoma recurrence after liver transplantation and analysis of prognostic factors for survival in a large Euro-American series[J]. Ann Surg Oncol, 2015, 22(7): 2286-2294.
102	Fernandez-Sevilla E, Allard MA, Selten J, et al. Recurrence of hepatocellular carcinoma after liver transplantation: Is there a place for resection？[J]. Liver Transpl, 2017, 23(4): 440-447.
103	de′Angelis N, Landi F, Carra MC, et al. Managements of recurrent hepatocellular carcinoma after liver transplantation: a systematic review[J]. World J Gastroenterol, 2015, 21(39): 11185-11198.
104	Tabrizian P, Holzner ML, Mehta N, et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma[J]. JAMA surgery, 2022, 157(9): 779-788.
105	Sposito C, Citterio D, Virdis M, et al. Therapeutic strategies for post-transplant recurrence of hepatocellular carcinoma[J]. World J Gastroenterol, 2022, 28(34): 4929-4942.
106	Bates MJ, Farkas E, Taylor D, et al. Pulmonary resection of metastatic hepatocellular carcinoma after liver transplantation[J]. Ann Thorac Surg, 2008, 85(2): 412-415.
107	Jeong YH, Hwang S, Lee GD, et al. Surgical outcome of pulmonary metastasectomy for hepatocellular carcinoma recurrence in liver transplant patients[J]. Ann Transplant, 2021, 26: e930383.
108	Hwang S, Kim YH, Kim DK, et al. Resection of pulmonary metastases from hepatocellular carcinoma following liver transplantation[J]. World J Surg, 2012, 36(7): 1592-1602.
109	Abdel Wahab M, Shehta A, Ibrahim EM, et al. Adrenalectomy for solitary recurrent hepatocellular carcinoma five years after living donor liver transplantation: a case report [J]. Int J Surg Case Rep, 2019, 54: 23-27.
110	Teegen EM, Mogl MT, Pratschke J, et al. Adrenal metastasis of hepatocellular carcinoma in patients following liver resection or liver transplantation: Experience from a tertiary referral center[J]. Int J Surg Oncol, 2018: 4195076.
111	Huang J, Yan L, Wu H, et al. Is radiofrequency ablation applicable for recurrent hepatocellular carcinoma after liver transplantation？[J]. J Surg Res, 2016, 200(1): 122-130.
112	Yang W, Wu H, Zhang ZY, et al. Long-term outcome of percutaneous radiofrequency ablation in recurrent hepatocellular carcinoma after liver transplantation[J]. Int J Hyperthermia, 2018, 34(1): 68-76.
113	Zhou B, Shan H, Zhu KS, et al. Chemoembolization with lobaplatin mixed with iodized oil for unresectable recurrent hepatocellular carcinoma after orthotopic liver transplantation[J]. J Vasc Interv Radiol, 2010, 21(3): 333-338.
114	Tan WF, Qiu ZQ, Yu Y, et al. Sorafenib extends the survival time of patients with multiple recurrences of hepatocellular carcinoma after liver transplantation[J]. Acta Pharmacol Sin, 2010, 31(12): 1643-1648.
115	Ishikawa T, Kubota T, Abe S, et al. Hepatic arterial infusion chemotherapy with cisplatin before radical local treatment of early hepatocellular carcinoma (JIS score 0/1) improves survival[J]. Ann Oncol, 2014, 25(7): 1379-1384.
116	何健，曾昭冲，杨平. 肝癌肝移植术后骨转移的放射治疗及其对预后的影响[J]. 实用肿瘤杂志，2012, 27(4): 332-337.
117	赵品婷，卢少平，梁昉，等. 肝癌移植术后肺内转移的体部伽玛刀应用分析[J]. 现代肿瘤医学，2011, 19(2): 290-291.
118	Au KP, Chiang CL, Chan ACY, et al. Initial experience with stereotactic body radiotherapy for intrahepatic hepatocellular carcinoma recurrence after liver transplantation [J]. World J Clin Cases, 2020, 8(13): 2758-2768.
119	Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma[J]. Gastroenterology, 2011, 140(2): 497-507.e2.
120	Zhang FJ, Li CX, Zhang L, et al. Short- to mid-term evaluation of CT-guided 125I brachytherapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma[J]. Cancer Biol Ther, 2009, 8(7): 585-590.
121	中国抗癌协会肝癌专业委员会转化治疗协作组. 原发性肝癌转化及围手术期治疗中国专家共识(2024版)[J]. 中华消化外科杂志，2024, 23(4): 492-513.
122	何凡，陈知水，曾凡军，等. 肝癌肝移植术后复发转移的综合治疗[J]. 中华消化外科杂志，2008, 7(4): 271-272.
123	Lee JO, Kim DY, Lim JH, et al. Palliative chemotherapy for patients with recurrent hepatocellular carcinoma after liver transplantation[J]. J Gastroenterol Hepatol, 2009, 24(5): 800-805.
124	Bruix J, Qin S, Merle P, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet, 2017, 389(10064): 56-66.
125	Yang Z, Wang S, Tian XY, et al. Impact of treatment modalities on patients with recurrent hepatocellular carcinoma after liver transplantation: Preliminary experience[J]. Hepatobiliary Pancreat Dis Int, 2020, 19(4): 365-370.
126	Li BCW, Chiu J, Shing K, et al. The outcomes of systemic treatment in recurrent hepatocellular carcinomas following liver transplants[J]. Adv Ther, 2021, 38(7): 3900-3910.
127	Ozbay MF, Harputluoglu H, Karaca M, et al. Sequential use of sorafenib and regorafenib in hepatocellular cancer recurrence after liver transplantation: Treatment strategies and outcomes[J]. Cancers (Basel), 2024, 16(22) ：3880.
128	Magyar CTJ, Perera S, Rajendran L, et al. Comparative outcome analysis of lenvatinib versus sorafenib for recurrence of hepatocellular carcinoma after liver transplantation[J]. Transplantation, 2025, 109(4)：681-690.
129	Tan PS, Muthiah MD, Koh T, et al. Asian Liver Transplant Network clinical guidelines on immunosuppression in liver transplantation[J]. Transplantation, 2019, 103(3): 470-480.
130	Wang Z, Zhou J, Fan J, et al. Effect of rapamycin alone and in combination with sorafenib in an orthotopic model of human hepatocellular carcinoma[J]. Clin Cancer Res, 2008, 14(16): 5124-5130.
131	Ren Z, Xu J, Bai Y, et al. Sintilimab plus a bevacizumab biosimilar (IBI305) versus sorafenib in unresectable hepatocellular carcinoma (ORIENT-32): a randomised, open-label, phase 2–3 study[J]. Lancet Oncol, 2021, 22(7): 977-990.
132	孙景奇，杨喆，刘见鹏，等. 6例免疫检查点抑制剂挽救性治疗肝癌肝移植术后肿瘤复发的初步评价[J]. 中华器官移植杂志，2022，43(7)：396-399.
133	DeLeon TT, Salomao MA, Aqel BA, et al. Pilot evaluation of PD-1 inhibition in metastatic cancer patients with a history of liver transplantation: the Mayo clinic experience[J]. J Gastrointest Oncol, 2018, 9(6): 1054-1062.
134	中华医学会器官移植学分会，中国医师协会器官移植医师分会肝移植学组，中国康复医学会器官移植康复专业委员会. 中国肝癌肝移植受者免疫检查点抑制剂应用专家共识(2024版) [J]. 中华器官移植杂志，2024, 45(7): 415-431.
135	Shi GM, Wang J, Huang XW, et al. Graft programmed death ligand 1 expression as a marker for transplant rejection following anti-programmed death 1 immunotherapy for recurrent liver tumors[J]. Liver Transpl, 2021, 27(3): 444-449.
136	樊嘉，高强，黄润. 肝癌精准治疗的研究前沿[J]. 中华肝脏病杂志，2020, 28(11)：897-900.
137	Huang A, Zhao X, Yang XR, et al. Circumventing intratumoral heterogeneity to identify potential therapeutic targets in hepatocellular carcinoma[J]. J Hepatol, 2017, 67(2): 293-301.
138	Hu B, Li H, Guo W, et al. Establishment of a hepatocellular carcinoma patient-derived xenograft platform and its application in biomarker identification[J]. Int J Cancer, 2020, 146(6): 1606-1617.
139	周俭，贺轶锋，黄晓武，等. 精准医疗时代肝癌肝移植围手术期诊断与治疗策略[J]. 中华消化外科杂志，2022, 21(2): 205-209.
140	Yarchoan M, Gane EJ, Marron TU, et al. Personalized neoantigen vaccine and pembrolizumab in advanced hepatocellular carcinoma: a phase 1/2 trial[J]. Nat Med, 2024, 30(4): 1044-1053.

证据等级	等级划分标准
A(高质量)	高质量的证据，包括随机对照的系统评价、随机对照试验、全或无病例
B(中等质量)	队列研究的系统评价、队列研究或较差的随机对照试验、"结果"研究及生态学研究
C(低质量)	病例对照研究的系统评价、病例对照研究
D(极低质量)	单个病例系列研究

证据等级	等级划分标准
A(高质量)	高质量的证据，包括随机对照的系统评价、随机对照试验、全或无病例
B(中等质量)	队列研究的系统评价、队列研究或较差的随机对照试验、"结果"研究及生态学研究
C(低质量)	病例对照研究的系统评价、病例对照研究
D(极低质量)	单个病例系列研究

[1]	Xiuling Yang, Wenhui Wang, Jie Yang, Qiang Lu. Contrast-enhanced ultrasound features of dual-phenotype versus classical hepatocellular carcinoma and risk factors for dual-phenotype hepatocellular carcinoma [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(08): 761-767.
[2]	Breast Disease Branch of Shenzhen Medical Association, Tumor Branch of Shenzhen Medical Association, Breast Specialist Physicians Branch of Shenzhen Medical Doctor Association, Breast Health and Rehabilitation Management Committee of Shenzhen Health Management Association, Breast Cancer Committee of Shenzhen Anti-Cancer Association, Tumor Radiation Therapy Committee of Shenzhen Anti-Cancer Association, Thyroid and Breast Diseases Committee of Shenzhen Integrated Traditional Chinese and Western Medicine Association. Expert consensus on efficacy prediction and evaluation of neoadjuvant therapy for breast cancer （2025 edition） [J]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(06): 321-330.
[3]	Long Dong, Yonghong Dong. Research progress on the role of melatonin in malignant tumors of the digestive system [J]. Chinese Archives of General Surgery(Electronic Edition), 2025, 19(06): 408-413.
[4]	Jiale Gao, Zhongtao Zhang. Latest advances and hotspots in the field of colorectal cancer surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(06): 595-599.
[5]	Chao Tian, Ruoxi Huang, Maolin Jiang, Chongwei Xie, Pengfei Diao, Suquan Zhong, Dong Chen, Hangtao Wang, Guiliu Chen, Yujian Chen, Guoliang Li. Risk factors and time distribution of pelvic lymph node metastasis after neoadjuvant chemotherapy in different subtypes of prostate cancer [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(06): 727-735.
[6]	Haoran Wang, Xinyuan Liu, Hua Fan. Application of ICG fluorescence imaging in perfusion and functional evaluation of liver graft [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 912-918.
[7]	Chengli Gao, Kaiming He, Xiao Feng, Kaining Zeng, Hui Tang, Jia Yao, Qing Yang, Huimin Yi, Shuhong Yi, Yang Yang, Binsheng Fu. Safety and efficacy of liver transplantation for children with inherited metabolic liver disease-A single-center analysis of 44 cases [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 844-851.
[8]	Shaojian Huang, Hanbiao Liang, Qingping Li, Shanhua Tang, Qingyan Li, Zhixi Li, Can Huang, Xiaozhen Wang, Canhui Chen, Kai Wang, Chuanjiang Li. Construction of prediction model for pathologic complete response of hepatocellular carcinoma after neoadjuvant/conversion therapy based on imageology and clinical features [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 860-867.
[9]	Jianwen Li, Ying Chen, Xi Chen, Xiaodan Zong. Application of Gd-EOB-DTPA enhanced MRI in differential diagnosis of small well-differentiated hepatocellular carcinoma and dysplastic nodules [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 875-881.
[10]	Xueli Yan, Deying Kong, Yinghui Hu, Junxi Xiang. Incidence and risk factors of immediate complications after orthotopic liver transplantation [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 894-901.
[11]	Menglong Wang. Impact of changes in hepatic blood flow in portal hypertension on liver transplantation and corresponding countermeasures [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(05): 687-692.
[12]	Bin Hu, Lin Liu. Correlation between dynamic changes in CT imaging features after neoadjuvant therapy and postoperative pathologic complete response rate in esophageal cancer [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(06): 627-634.
[13]	Hui Yuan, Luzhong Zhou, Henian Tang, Juhua Pan. Evaluation of the prognostic of LMR and PHR in patients with hepatocellular carcinoma undergoing radiofrequency ablation [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(06): 635-641.
[14]	Longfu Xi, Jiangtao Li. Advances in understanding of role of CXCL12 and its receptors CXCR4/CXCR7 in liver-related diseases [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(09): 714-719.
[15]	Shilun Wu, Changyu Yao, Li Xu, Zhishan Di, Qi Xia, Wenbing Sun, Jian Kong. Progress in understanding the role of tumor-associated macrophages in hepatocellular carcinoma angiogenesis [J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(05): 388-391.

Please choose a citation manager

Content to export