肝细胞癌微血管侵犯术后早期复发的研究进展  

Research advances in early postoperative recurrence of hepatocellular carcinoma with microvascular invasion

作　　者：王恺悌 巴登才仁·安蕊 丛赟 张瑞青[1] 邵英梅[1,2] 吐尔干艾力·阿吉 WANG Kaiti;BADENGCAIREN Anrui;CONG Yun;ZHANG Ruiqing;SHAO Yingmei;TUERGANAILI Aji(Department of Hepatobiliary Hydatid Disease Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.China;State Key Laboratory of Central Asian High-Prevalence Disease Etiology and Prevention,Xinjiang Medical University,Urumqi 830054,P.R.China)

机构地区：[1]新疆医科大学第一附属医院肝胆包虫病外科,乌鲁木齐830054 [2]新疆医科大学省部共建中亚高发病成因与防治国家重点实验室,乌鲁木齐830054

出　　处：《中国普外基础与临床杂志》2024年第11期1399-1405,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：新疆维吾尔自治区高校科研计划自然科学重点项目(项目编号:XJEDU2021I016);省部共建中亚高发病成因与防治国家重点实验室开放课题项目(项目编号:SKL-HIDCA-2020-BC);省部共建中亚高发病成因与防治国家重点实验室开放课题项目(项目编号:SKL-HIDCA-2021-12);新疆维吾尔自治区自然科学基金资助项目(项目编号:2022D01C219);自治区高校基本科研业务费科研项目(项目编号:XJEDU2024J054)。

摘　　要：目的 总结微血管侵犯(microvascular invasion,MVI)对肝细胞癌根治性肝切除术后患者生存预后的影响,分析其相关危险因素及预测方法,并为术后早期复发的治疗提供参考和支持。方法 通过检索国内外医学文献数据库,筛选与肝细胞癌MVI相关的研究,重点分析MVI的定义、分级、危险因素、术前预测方法和术后治疗策略,并对现有研究成果进行总结。结果 MVI是肝细胞癌肝内转移和术后早期复发的危险因素。目前可用于预测MVI的方法主要包括检验指标、影像组学和基因组学,其中检验指标包括甲胎蛋白、异常凝血酶原、乙型肝炎病毒、肿瘤直径、血管表皮生长因子A、循环肿瘤细胞;影像组学特征包括术前MRI表现为肿瘤不规则形状且体素内不相干运动弥散加权成像D值<1.16×10-3mm^(2)/S、CT增强影像征象中肿瘤边缘不光滑、肿瘤多灶性、超声造影门静脉期和延迟期评分;基因组学包括循环肿瘤DNA的最大变异等位基因频率。对于MVI阳性的术后患者,辅助治疗引起广泛关注,如经导管动脉化疗栓塞术、经肝动脉持续灌注化疗、靶向治疗、免疫治疗、放射疗法、抗病毒治疗、局部治疗联合系统治疗等。结论 MVI的研究及其针对性治疗策略对降低肝细胞癌术后复发率和提高患者生存率具有重要意义,未来应优化术前预测模型和术后治疗方案,为患者提供更有效的治疗参考。Objective To explore the impact of microvascular invasion(MVI)on the survival prognosis of patients after radical hepatectomy for hepatocellular carcinoma,to analyze its related risk factors and preoperative prediction methods,and to provide reference and support for the treatment of early postoperative recurrence.Methods By searching domestic and international medical literature databases,we screened studies related to MVI in hepatocellular carcinoma,focusing on the definition,grading,risk factors,preoperative prediction methods,and postoperative treatment strategies of MVI,and summarized the results of the existing studies.Results MVI was a well-established risk factor for the intrahepatic metastasis and early postoperative recurrence of hepatocellular carcinoma.Currently,various methods were employed to predict MVI,including laboratory indicators,imaging genomics,and genomics.The laboratory indicators used for prediction included alpha-fetoprotein,protein induced by vitamin K absence or antagonist-Ⅱ,hepatitis B virus,tumor diameter,vascular endothelial growth factor A,and circulating tumor cells.Imaging genomics involved preoperative MRI with irregular tumor shape and intra-voxel incoherent motion diffusion-weighted imaging Dvalue < 1.16 × 10-3 mm^(2)/S, CT enhancement imaging features with irregular tumor margins, multiple foci, and contrastenhancedultrasound portal venous and delayed phase scores. Genomics included the maximum variant allele frequency ofcirculating tumor DNA. In cases where MVI was detected after surgery, adjuvant therapy options had gained attention,such as transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, targeted therapy,immunotherapy, radiation therapy, antiviral therapy, and local treatment combined with systemic treatment. Conclusions Thestudy of MVI and its targeted treatment strategies are important for reducing the postoperative recurrence rate ofhepatocellular carcinoma and improving patient survival. The preoperative prediction model and postoper

关 键 词：肝细胞癌 微血管侵犯 复发转移 治疗 根治性肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]