肝癌肝移植分配政策的优化与新模型探索

肝脏 ›› 2025, Vol. 30 ›› Issue (7): 892-897.

肝癌肝移植分配政策的优化与新模型探索

张承乾, 苏晓静, 刘俊杰, 夏勇, 沈皓, 沈锋

510006 广州广东药科大学第一临床医学院(张承乾,沈锋);200093 上海上海理工大学(苏晓静,沈锋);200438 海军军医大学第三附属医院(东方肝胆外科医院)肝外四科(刘俊杰,夏勇,沈锋);200438 海军军医大学第三附属医院(东方肝胆外科医院)临床研究院(沈皓,沈锋)

收稿日期:2025-06-02 出版日期:2025-07-31 发布日期:2025-08-11
通讯作者: 沈锋,Email:shenfengehbh@sina.com
基金资助:
海军军医大学第三附属医院示范性研究型病房项目(No.SHDC2023CRW002)

Received:2025-06-02 Online:2025-07-31 Published:2025-08-11

摘要/Abstract

摘要： 肝癌肝移植作为终末期肝癌的重要治疗手段,其临床价值受到供体肝源稀缺性的制约,这使得科学合理的分配政策成为关键。本文系统梳理了肝癌肝移植分配标准的演进历程,包括国际标准和国内标准的发展,以及终末期肝病模型(MELD)评分系统的引入与改进。针对当前分配体系难以精准区分肝癌患者内部风险层级的问题,本文重点探讨了新兴的Multi-HCC模型,该模型创新性地整合了肝功能(MELD 3.0)、肿瘤活性标志(AFP)和影像学肿瘤负荷等客观指标,构建动态风险分层工具,可量化预测患者等待期脱落风险并生成等效MELD 3.0评分,实现高危患者优先权提升(等待脱落率20.5% vs. 低危组3.5%)与资源优化(52.6%低危患者降级),并保障各层级患者移植后5年生存率维持在70%以上的临床安全基线。未来需突破AFP阴性患者判别瓶颈,整合AFP-L3 / DCP等新型标志物,开发动态算法,并协同政策解决优先级平衡问题,推动分配体系向个体化精准分层转型。

关键词: 肝癌, 肝移植, 分配政策, MELD评分, Multi-HCC模型

张承乾, 苏晓静, 刘俊杰, 夏勇, 沈皓, 沈锋. 肝癌肝移植分配政策的优化与新模型探索[J]. 肝脏, 2025, 30(7): 892-897.

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