ABSTRACT

Introduction

Recurrence is the driving factor for reduced long-term survival in patients following resected hepatocellular carcinoma (HCC). Extensive research efforts have been conducted to understand the molecular processes precipitating disease recurrence. Modern genomic techniques have identified two distinct mechanisms for recurrent HCC (RHCC): Intrahepatic metastasis (IM-HCC); and multicentric origin (MO-HCC). Medline, EMBASE and Cochrane library were methodically searched for primary research articles in English with the aim of appraising existing literature on the identification of clonal origin of RHCC and its potential clinical utility.

Areas covered

Molecular and next-generation sequencing techniques, when applied to clonal origin identification, yield superior accuracy than traditional clinicopathological criteria. Despite various treatment modalities, no optimal therapy has yet been identified for treating clonally differentiated RHCC. Patients with MO-HCC appear to experience improved long-term survival following re-treatment compared to their IM-HCC counterparts (91.7% vs 22.9% 5-year survival, p < 0.001). However, cautious interpretation is advised as heterogeneous classification criteria and small sample sizes restrict the generalizability of such findings.

Expert opinion

Improved identification of clonal origin in RHCC may facilitate further research on RHCC treatment strategies and enable the development of novel therapeutic targets, potentially leading to individualized treatment approaches in the future.

中文翻译：

---

克隆起源测定在治疗复发性肝细胞癌中的临床应用

摘要

介绍

复发是肝细胞癌 (HCC) 切除术后患者长期生存率降低的驱动因素。已经进行了广泛的研究工作以了解导致疾病复发的分子过程。现代基因组技术已经确定了复发性 HCC (RHCC) 的两种不同机制：肝内转移 (IM-HCC)；和多中心起源（MO-HCC）。Medline、EMBASE 和 Cochrane 图书馆有条不紊地搜索了英文的主要研究文章，目的是评估现有的关于鉴定 RHCC 克隆起源及其潜在临床效用的文献。

涵盖的领域

分子和下一代测序技术在应用于克隆起源鉴定时，比传统的临床病理学标准具有更高的准确性。尽管有各种治疗方式，但尚未确定治疗克隆分化 RHCC 的最佳疗法。与 IM-HCC 患者相比，MO-HCC 患者在再治疗后的长期生存率似乎有所提高（91.7% 对 22.9% 的 5 年生存率，p < 0.001）。然而，建议谨慎解释，因为异质的分类标准和小样本量限制了这些发现的普遍性。

专家意见

改进 RHCC 中克隆起源的鉴定可能有助于进一步研究 RHCC 治疗策略，并能够开发新的治疗靶点，从而可能导致未来的个体化治疗方法。