Prognostic and Therapeutic Implications of Microvascular Invasion in Hepatocellular Carcinoma
Prognostic and Therapeutic Implications of Microvascular Invasion in Hepatocellular Carcinoma
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DOI：
10.1245/s10434-019-07227-9
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发表时间：
2019-05-01
影响因子：
3.7
通讯作者：
Tanabe, Kenneth K.
中科院分区：
文献类型：
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作者：
Erstad, Derek J.;Tanabe, Kenneth K.
肝细胞癌是一种病态疾病，手术和消融治疗是治愈的唯一选择。尽管如此，超过一半的接受R0切除术的患者会出现复发。早期复发在切除后2年内被认为是由于残留的显微疾病的存在，而晚期复发和切除后2年被认为是发生在慢性损伤的肝组织中的新生的异时性肝癌。微血管侵袭(MVI)被定义为肝血管内存在微转移的肝癌栓子，是早期复发和生存的关键决定因素。在这篇综述中，我们总结了MVI的发病机制和临床意义，MVI与不良的生物学特征相关，包括高级别、肿瘤大小和上皮-间充质转化。已经提出了多种分类模式来捕捉与预后相关的MVI的异质性特征。然而，目前MVI只能根据手术标本确定，限制了其临床应用。展望未来，轴位成像技术、活检组织的分子特征和新的血清生物标记物的进步有望成为未来无创MVI检测的方法。最终，MVI状态可用于帮助临床医生确定治疗计划，特别是在手术干预方面，并提供更准确的预后。
Hepatocellular carcinoma (HCC) is a morbid condition for which surgical and ablative therapy are the only options for cure. Nonetheless, over half of patients treated with an R0 resection will develop recurrence. Early recurrences within 2 years after resection are thought to be due to the presence of residual microscopic disease, while late recurrences > 2 years after resection are thought to be de novo metachronous HCCs arising in chronically injured liver tissue. Microvascular invasion (MVI) is defined as the presence of micrometastatic HCC emboli within the vessels of the liver, and is a critical determinant of early recurrence and survival. In this review, we summarize the pathogenesis and clinical relevance of MVI, which correlates with adverse biological features, including high grade, large tumor size, and epithelial-mesenchymal transition. Multiple classification schemas have been proposed to capture the heterogeneous features of MVI that are associated with prognosis. However, currently, MVI can only be determined based on surgical specimens, limiting its clinical applicability. Going forward, advances in axial imaging technologies, molecular characterization of biopsy tissue, and novel serum biomarkers hold promise as future methods for non-invasive MVI detection. Ultimately, MVI status may be used to help clinicians determine treatment plans, particularly with respect to surgical intervention, and to provide more accurate prognostication.