原发性肝癌早期筛查与诊断的研究进展

Advances in Early Screening and Diagnosis of Primary Liver Cancer

摘要: 原发性肝癌(Primary Liver Cancer, PLC)是全球最常见的恶性肿瘤之一，尤其是在我国发病率较高。早期筛查与诊断是改善患者预后的关键，近年来技术进步为肝癌的早期发现带来了新的希望。本文综述了影像学技术、血清标志物和基因检测在肝癌早期筛查中的研究进展。影像学技术方面，造影剂增强超声(Contrast Enhancement Ultrasonography, CEUS)和动态增强MRI结合人工智能分析，大幅提升了小肝癌的检出率。血清标志物的研究不仅限于传统的甲胎蛋白(AFP)，AFP-L3和PIVKA-II的联合检测展现了更高的敏感性和特异性。此外，最新的蛋白质组学研究利用SomaScan平台识别出多个潜在的血清蛋白标志物，有望为非侵入性早期筛查提供新工具。基因检测方面，循环肿瘤DNA (ctDNA)和外泌体检测技术取得了显著进展，新开发的HCC EV SPA方法显示出在肝硬化背景下识别早期肝癌的优势。未来，随着AI、大数据技术的进一步应用，影像学、血清标志物和基因检测的多重联合检测有望成为肝癌早期诊断的标准流程，提高筛查的精准性和患者生存率。

Abstract: Primary Liver Cancer (PLC) is one of the most common malignancies worldwide, with particularly high incidence rates in China. Early screening and diagnosis are crucial for improving patient prognosis, and recent technological advancements have brought new hope for the early detection of liver cancer. This article reviews the research progress in imaging technologies, serum biomarkers, and genetic testing for the early screening of liver cancer. In terms of imaging technologies, contrast-enhanced ultrasonography (CEUS) and dynamic contrast-enhanced MRI, combined with artificial intelligence analysis, have significantly improved the detection rate of small liver cancers. For serum biomarkers, research is no longer limited to traditional alpha-fetoprotein (AFP). The combined detection of AFP-L3 and PIVKA-II has demonstrated higher sensitivity and specificity. Furthermore, recent proteomics studies using the SomaScan platform have identified several potential serum protein biomarkers, offering promising new tools for non-invasive early screening. Regarding genetic testing, significant progress has been made in circulating tumor DNA (ctDNA) and exosome detection technologies. A newly developed method, HCC EV SPA, has shown advantages in identifying early liver cancer against a background of liver cirrhosis. Looking ahead, with the further application of AI and big data technologies, the multi-modal combination of imaging, serum biomarkers, and genetic testing is expected to become the standard protocol for early liver cancer diagnosis, enhancing screening accuracy and improving patient survival rates.