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目的:探讨肝再生过程如何促进转移肿瘤的复发及相关机制,阐述肝再生的临床重要性及分子机制。方法:应用Medline及PubMed期刊全文数据库检索系统,以“肝再生,肝转移瘤,肝切除术,肿瘤复发”等为检索词,检索2007-01-2012-03的相关文献,共检索到英文文献365条。纳入标准:1)肝部分切除术后肝脏再生;2)肝转移瘤复发;3)肝转移瘤术后与肿瘤复发的关系,符合分析的文献50篇。结果:肝脏再生是一个涉及多种效应细胞增殖反应和多种细胞因子表达调控的精密过程。这些因子如肝细胞生长因子(HGF),转化生长因子-β(TGF-β)和基质金属蛋白酶(MMPs)不仅能促进肝再生,也能促使肝转移肿瘤的复发。休眠期微转移瘤的激活和循环癌细胞在肝内的集聚被认为是肝转移肿瘤术后复发的相关机制,此机制尚未完全了解。结论:肝再生能促使肝转移肿瘤术后复发。尽管过去10年,相关肿瘤复发机制的研究有明显的进步,但是关于肝再生及其对肝部分切除术(PHx)后肿瘤复发的许多疑问,有待于进一步解决。
Objective: To investigate how the process of liver regeneration can promote the recurrence of metastatic tumor and related mechanisms, and elucidate the clinical significance and molecular mechanism of liver regeneration. METHODS: Medline and PubMed journal full-text database retrieval system were used to search the relevant articles of 2007-01-2012-03 with the terms of “liver regeneration, liver metastases, hepatectomy, tumor recurrence” and so on English literature 365. Inclusion criteria: 1) liver regeneration after partial hepatectomy; 2) recurrence of liver metastases; 3) the relationship between liver metastases and tumor recurrence, in line with the literature analyzed 50. Results: Liver regeneration is a delicate process involving multiple effector cell proliferation responses and the regulation of various cytokines. These factors such as hepatocyte growth factor (HGF), transforming growth factor-β (TGF-β) and matrix metalloproteinases (MMPs) not only promote liver regeneration, but also promote the recurrence of liver metastases. Activation of micrometastases in the dormant period and the accumulation of circulating cancer cells in the liver are thought to be related mechanisms of postoperative recurrence of liver metastases, a mechanism that has not yet been fully understood. Conclusion: Liver regeneration can promote the recurrence of liver metastases after operation. Although there has been significant improvement in the mechanisms of tumor relapse in the past decade, many questions regarding liver regeneration and tumor recurrence after partial hepatectomy (PHx) need to be further resolved.