肝细胞癌微血管浸润术前预测研究进展

Research Progress on Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma

摘要: 目的：探讨肝细胞癌(HCC)微血管侵犯(MVI)的发生机制、术前预测新策略及其对临床精准诊疗的指导价值。方法：系统回顾相关文献，重点分析“炎症–癌症”轴及上皮–间质转化(EMT)在MVI形成中的病理作用，评估血清标志物、液体活检及人工智能影像组学的预测效能，并探讨MVI状态对治疗决策的影响。结果：MVI的发生植根于慢性炎症微环境，涉及中性粒细胞胞外诱捕网(NETs)释放及巨噬细胞极化等机制。在术前预测方面，异常凝血酶原(PIVKA-II)及系统免疫炎症指数(SII)显示出优于甲胎蛋白(AFP)的诊断价值；循环肿瘤细胞(CTC)和ctDNA等液体活检技术揭示了早期微转移的分子特征。特别是基于深度学习的多模态影像模型(如DL-TriFusion)，通过整合影像与临床特征，显著提升了预测的灵敏度与特异性。结论：MVI是HCC术后复发的核心危险因素。构建高精度的多模态术前预测体系，对于制定个体化治疗方案至关重要。它不仅指导外科手术方式的选择(如解剖性肝切除)，还为筛选围手术期辅助治疗(如HAIC)及靶向免疫治疗的获益人群提供了科学依据。未来需开展多中心前瞻性研究以推动其临床转化。

Abstract: Objective: To explore the pathogenesis of microvascular invasion (MVI) in hepatocellular carcinoma (HCC), novel preoperative prediction strategies, and their guiding value for precision clinical diagnosis and treatment. Methods: A systematic review of relevant literature was conducted, focusing on the pathological roles of the inflammation-cancer axis and epithelial-mesenchymal transition (EMT) in MVI formation. The predictive efficacy of serum biomarkers, liquid biopsy, and artificial intelligence-based radiomics was evaluated, and the impact of MVI status on treatment decisions was investigated. Results: The occurrence of MVI is rooted in a chronic inflammatory microenvironment, involving mechanisms such as neutrophil extracellular traps (NETs) release and macrophage polarization. In terms of preoperative prediction, abnormal prothrombin-II (PIVKA-II) and systemic immune inflammatory index (SII) showed superior diagnostic value compared to alpha-fetoprotein (AFP). Liquid biopsy techniques such as circulating tumor cells (CTC) and ctDNA revealed the molecular characteristics of early micrometastases. In particular, deep learning-based multimodal imaging models (such as DL-TriFusion) significantly improved the sensitivity and specificity of prediction by integrating imaging and clinical features. Conclusion: MVI is a core risk factor for HCC recurrence after surgery. Constructing a high-precision, multimodal preoperative prediction system is crucial for developing individualized treatment plans. It not only guides the selection of surgical procedures (such as anatomical hepatectomy) but also provides a scientific basis for screening patients who will benefit from perioperative adjuvant therapy (such as HAIC) and targeted immunotherapy. Future multicenter prospective studies are needed to promote its clinical translation.