肝细胞癌伴发门静脉癌栓的理解与诊断研究进展
Advances in the Understanding and Diagnosis of Hepatocellular Carcinoma Associated with Portal Vein Tumor Thrombosis
DOI: 10.12677/hjs.2024.134011, PDF,    国家自然科学基金支持
作者: 郭 臣, 张 恺, 刘 鑫, 田芳铭, 王 琳*:昆明医科大学第二附属医院肝胆外科二病区,云南 昆明
关键词: 肝细胞癌门静脉癌栓发生分类诊断Hepatocellular Carcinoma Portal Vein Tumor Thrombosis Incidence Typing Diagnosis
摘要: 肝细胞癌(HCC)伴发门静脉癌栓(PVTT)是肝癌治疗领域的一大难题,对患者的预后构成严重威胁。近年来,随着医学研究的不断深入,我们逐渐认识到HCC的发展与PVTT的形成之间存在错综复杂的生物学联系,这涉及到细胞增殖的失控、血管新生的异常、细胞凋亡的紊乱以及免疫反应的失调等多个方面。本综述将全面梳理近年来关于肝癌患者门脉癌栓形成机制的研究成果,详细介绍其分类、诊断方法,提供临床医师更为深入的理论支撑和实践参考,对早期诊断的患者做出及时干预并制定策略,共同推动肝癌治疗领域的发展。
Abstract: Hepatocellular carcinoma (HCC) complicated by Portal Vein Tumor Thrombosis (PVTT) poses a significant challenge in the field of liver cancer treatment and critically affects patient prognosis. Recent advances in medical research have progressively revealed complex biological relationships between the development of HCC and the formation of PVTT. These include uncontrolled cellular proliferation, aberrant angiogenesis, disrupted apoptosis, and dysregulated immune response. This review comprehensively summarizes recent research findings on the mechanisms underlying PVTT formation in patients with liver cancer. It elaborates on classification and diagnostic approaches, providing clinicians with deeper theoretical insights and practical guidance. This review aims to support timely intervention and strategic planning for patients diagnosed early, thereby contributing to advancements in liver cancer treatment.
文章引用:郭臣, 张恺, 刘鑫, 田芳铭, 王琳. 肝细胞癌伴发门静脉癌栓的理解与诊断研究进展[J]. 外科, 2024, 13(4): 80-86. https://doi.org/10.12677/hjs.2024.134011

参考文献

[1] Gordan, J.D., Kennedy, E.B., Abou-Alfa, G.K., Beg, M.S., Brower, S.T., Gade, T.P., et al. (2020) Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline. Journal of Clinical Oncology, 38, 4317-4345. [Google Scholar] [CrossRef] [PubMed]
[2] Akinyemiju, T., Abera, S., Ahmed, M., Alam, N., Alemayohu, M.A., Allen, C., et al. (2017) The Burden of Primary Liver Cancer and Underlying Etiologies from 1990 to 2015 at the Global, Regional, and National Level: Results from the Global Burden of Disease Study 2015. JAMA Oncology, 3, 1683-1691. [Google Scholar] [CrossRef] [PubMed]
[3] El-Khoueiry, A.B., Sangro, B., Yau, T., Crocenzi, T.S., Kudo, M., Hsu, C., et al. (2017) Nivolumab in Patients with Advanced Hepatocellular Carcinoma (Checkmate 040): An Open-Label, Non-Comparative, Phase 1/2 Dose Escalation and Expansion Trial. The Lancet, 389, 2492-2502. [Google Scholar] [CrossRef] [PubMed]
[4] Killock, D. (2017) Nivolumab Keeps HCC in Check and Opens Avenues for Checkmate. Nature Reviews Clinical Oncology, 14, 392-392. [Google Scholar] [CrossRef] [PubMed]
[5] Galle, P.R., Forner, A., Llovet, J.M., Mazzaferro, V., Piscaglia, F., Raoul, J., et al. (2018) EASL Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. Journal of Hepatology, 69, 182-236. [Google Scholar] [CrossRef] [PubMed]
[6] Yang, P., Li, Q., Feng, Y., Zhang, Y., Markowitz, G.J., Ning, S., et al. (2012) TGF-β-miR-34a-CCL22 Signaling-Induced Treg Cell Recruitment Promotes Venous Metastases of HBV-Positive Hepatocellular Carcinoma. Cancer Cell, 22, 291-303. [Google Scholar] [CrossRef] [PubMed]
[7] Ye, L., Chen, W., Bai, X., Xu, X., Zhang, Q., Xia, X., et al. (2016) Hypoxia-Induced Epithelial-To-Mesenchymal Transition in Hepatocellular Carcinoma Induces an Immunosuppressive Tumor Microenvironment to Promote Metastasis. Cancer Research, 76, 818-830. [Google Scholar] [CrossRef] [PubMed]
[8] Guo, W., Liu, S., Cheng, Y., Lu, L., Shi, J., Xu, G., et al. (2016) Icam-1-Related Noncoding RNA in Cancer Stem Cells Maintains ICAM-1 Expression in Hepatocellular Carcinoma. Clinical Cancer Research, 22, 2041-2050. [Google Scholar] [CrossRef] [PubMed]
[9] Wei, X., Li, N., Li, S., Shi, J., Guo, W., Zheng, Y., et al. (2017) Hepatitis B Virus Infection and Active Replication Promote the Formation of Vascular Invasion in Hepatocellular Carcinoma. BMC Cancer, 17, Article No. 304. [Google Scholar] [CrossRef] [PubMed]
[10] Li, Z., Zhao, M., Qi, X., Tang, Y. and Cheng, S. (2023) Mechanisms of Portal Vein Tumour Thrombus Formation and Development in Patients with Hepatocellular Carcinoma. Journal of Cellular and Molecular Medicine, 27, 2103-2111. [Google Scholar] [CrossRef] [PubMed]
[11] Kudo, M., Kitano, M., Sakurai, T. and Nishida, N. (2015) General Rules for the Clinical and Pathological Study of Primary Liver Cancer, Nationwide Follow-Up Survey and Clinical Practice Guidelines: The Outstanding Achievements of the Liver Cancer Study Group of Japan. Digestive Diseases, 33, 765-770. [Google Scholar] [CrossRef] [PubMed]
[12] Ikai, I., Yamamoto, Y., Yamamoto, N., Terajima, H., Hatano, E., Shimahara, Y., et al. (2003) Results of Hepatic Resection for Hepatocellular Carcinoma Invading Major Portal And/or Hepatic Veins. Surgical Oncology Clinics of North America, 12, 65-75. [Google Scholar] [CrossRef] [PubMed]
[13] Cheng, S.Q., Wu, M.C., Chen, H., et al. (2004)[Significance of Typing of Tumor Thrombi in Determination of Treatment and Assessment of Prognosis of Hepatocellular Carcinoma with Tumor Thrombi in the Portal Vein]. Chinese Medical Journal, 84, 3-5.
[14] Shi, J., Lai, E.C.H., Li, N., Guo, W., Xue, J., Lau, W., et al. (2010) A New Classification for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. Journal of Hepato-Biliary-Pancreatic Sciences, 18, 74-80. [Google Scholar] [CrossRef] [PubMed]
[15] 刘允怡. 肝癌合并门静脉癌栓现存分期的不足[J]. 中华消化外科杂志, 2018, 17(5): 423-425.
[16] Gon, H., Kido, M., Tanaka, M., Kinoshita, H., Komatsu, S., Tsugawa, D., et al. (2018) Growth Velocity of the Portal Vein Tumor Thrombus Accelerated by Its Progression, Alpha-Fetoprotein Level, and Liver Fibrosis Stage in Patients with Hepatocellular Carcinoma. Surgery, 164, 1014-1022. [Google Scholar] [CrossRef] [PubMed]
[17] Yu, J., Li, Y., Shu, C., Yang, H., Huang, Z., Tao, R., et al. (2023) Prognostic Value of Preoperative Circulating Tumor Cells for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Propensity Score Analysis. Journal of Cancer Research and Clinical Oncology, 149, 8981-8991. [Google Scholar] [CrossRef] [PubMed]
[18] 童敬澍,马浙平, 毛书奇, 等. 异常凝血酶原对肝癌合并门静脉癌栓的预测价值[J]. 2022, 34(1): 23-29.
[19] Qi, L., Ma, L., Wu, F., Chen, Y., Xing, W., Jiang, Z., et al. (2021) S100P as a Novel Biomarker of Microvascular Invasion and Portal Vein Tumor Thrombus in Hepatocellular Carcinoma. Hepatology International, 15, 114-126. [Google Scholar] [CrossRef] [PubMed]
[20] Wang, W. (2022) Progress in Clinical Evaluation of Hepatocellular Carcinoma Complicated with Portal Vein Tumor Thrombus. Advances in Clinical Medicine, 12, 11129-11134. [Google Scholar] [CrossRef
[21] Margini, C. and Berzigotti, A. (2017) Portal Vein Thrombosis: The Role of Imaging in the Clinical Setting. Digestive and Liver Disease, 49, 113-120. [Google Scholar] [CrossRef] [PubMed]
[22] 李红学, 刘军杰, 赵盛发, 等. 超声造影在门脉癌栓诊断和分型中的临床价值[J]. 吉林大学学报(医学版), 2016, 42(2): 380-384.
[23] Dodd, G.D., Memel, D.S., Baron, R.L., Eichner, L. and Santiguida, L.A. (1995) Portal Vein Thrombosis in Patients with Cirrhosis: Does Sonographic Detection of Intrathrombus Flow Allow Differentiation of Benign and Malignant Thrombus? American Journal of Roentgenology, 165, 573-577. [Google Scholar] [CrossRef] [PubMed]
[24] Tarantino, L., Francica, G., Sordelli, I., Esposito, F., Giorgio, A., Sorrentino, P., et al. (2006) Diagnosis of Benign and Malignant Portal Vein Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma: Color Doppler US, Contrast-Enhanced US, and Fine-Needle Biopsy. Abdominal Imaging, 31, 537-544. [Google Scholar] [CrossRef] [PubMed]
[25] Tarantino, L. (2015) Contrast-Enhanced Ultrasound in Differentiating Malignant from Benign Portal Vein Thrombosis in Hepatocellular Carcinoma. World Journal of Gastroenterology, 21, 9457-9460. [Google Scholar] [CrossRef] [PubMed]
[26] Matuzak, A.R. (2012) Sonography of Portal Vein Tumor Thrombus Associated with HCC Journal of Diagnostic Medical Sonography, 29, 44-47. [Google Scholar] [CrossRef
[27] 潘春涵, 沈文荣, 乔伟, 等. 肝细胞肝癌并门脉癌栓的CT灌注成像及治疗方法概述[J]. 中国肿瘤外科杂志, 2022, 14(5): 504-508.
[28] 李宏, 徐小虎, 彭进, 等. CT门静脉造影三维重建诊断门静脉癌栓的价值[J]. 中国CT和MRI杂志, 2022, 20(12): 101-102.
[29] Sun, H., Zhou, J., Wang, Z., Liu, X., Xie, Q., Jia, W., et al. (2022) Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma (2021 Edition). Hepatobiliary Surgery and Nutrition, 11, 227-252. [Google Scholar] [CrossRef] [PubMed]
[30] Ahn, J., Yu, J., Cho, E., Chung, J., Kim, J.H. and Kim, K.W. (2016) Diffusion-Weighted MRI of Malignant versus Benign Portal Vein Thrombosis. Korean Journal of Radiology, 17, 533-540. [Google Scholar] [CrossRef] [PubMed]
[31] Catalano, O.A., Choy, G., Zhu, A., Hahn, P.F. and Sahani, D.V. (2010) Differentiation of Malignant Thrombus from Bland Thrombus of the Portal Vein in Patients with Hepatocellular Carcinoma: Application of Diffusion-Weighted MR Imaging. Radiology, 254, 154-162. [Google Scholar] [CrossRef] [PubMed]
[32] Almuhaideb, A., Papathanasiou, N. and Bomanji, J. (2011) 18F-FDG PET/CT Imaging in Oncology. Annals of Saudi Medicine, 31, 3-13. [Google Scholar] [CrossRef] [PubMed]
[33] Wu, B., Zhang, Y., Tan, H. and Shi, H. (2019) Value of 18F-FDG PET/CT in the Diagnosis of Portal Vein Tumor Thrombus in Patients with Hepatocellular Carcinoma. Abdominal Radiology, 44, 2430-2435. [Google Scholar] [CrossRef] [PubMed]
[34] Fonti, R., Conson, M. and Del Vecchio, S. (2019) PET/CT in Radiation Oncology. Seminars in Oncology, 46, 202-209. [Google Scholar] [CrossRef] [PubMed]
[35] Su, G.L., Altayar, O., O’Shea, R., Shah, R., Estfan, B., Wenzell, C., et al. (2022) AGA Clinical Practice Guideline on Systemic Therapy for Hepatocellular Carcinoma. Gastroenterology, 162, 920-934. [Google Scholar] [CrossRef] [PubMed]
[36] Kudo, M., Kawamura, Y., Hasegawa, K., Tateishi, R., Kariyama, K., Shiina, S., et al. (2021) Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update. Liver Cancer, 10, 181-223. [Google Scholar] [CrossRef] [PubMed]
[37] 梅铭惠, 陈谦, 杨景红, 等. 肝癌合并门静脉癌栓的临床病理分级及意义[J]. 中华肝胆外科杂志, 2006, 12(6): 374-377.
[38] Arakawa, M., Kage, M., Matsumoto, S., Akagi, Y., Noda, T., Fukuda, K., et al. (1986) Frequency and Significance of Tumor Thrombi in Esophageal Varices in Hepatocellular Carcinoma Associated with Cirrhosis. Hepatology, 6, 419-422. [Google Scholar] [CrossRef] [PubMed]
[39] 胡建新, 刘秀颀, 李德民, 等. 肝癌门静脉癌栓影像学分型与临床病理分型的对比研究[J]. 河北医药, 2015, 37(1): 88-89.