切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 313 -324. doi: 10.3877/cma.j.issn.1674-0793.2024.05.001

专家共识

肝细胞癌伴微血管侵犯诊断和治疗中国专家共识(2024版)
中国医师协会肝癌专业委员会   
  1. 1. 海军军医大学第三附属医院,上海 200438
  • 收稿日期:2024-09-20 出版日期:2024-10-01
  • 基金资助:
    国家重点研发计划(2022YFC2503705); 国家自然科学基金(82072618); 上海市卫健委"重中之重"项目(2023ZZ02005)

Chinese expert consensus on the diagnosis and treatment of hepatocellular carcinoma with microvascular invasion (2024 edition)

Chinese Association of Liver Cancer of Chinese Medical Doctor Association   

  1. 1. the Third Affiliated Hospital of Naval Medical University, Shanghai 200438, China
  • Received:2024-09-20 Published:2024-10-01
引用本文:

中国医师协会肝癌专业委员会. 肝细胞癌伴微血管侵犯诊断和治疗中国专家共识(2024版)[J]. 中华普通外科学文献(电子版), 2024, 18(05): 313-324.

Chinese Association of Liver Cancer of Chinese Medical Doctor Association. Chinese expert consensus on the diagnosis and treatment of hepatocellular carcinoma with microvascular invasion (2024 edition)[J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(05): 313-324.

肝细胞癌(以下简称肝癌)是我国常见的恶性肿瘤之一,手术切除是首选的治疗方法,但术后复发转移率高。目前证据表明微血管侵犯(MVI)是导致肝癌复发转移的独立危险因素,但是目前国际上对于MVI的诊断、分型、预测和治疗仍存在较多争议。为更好地指导肝癌伴MVI的诊断和治疗,中国医师协会肝癌专业委员会组织国内相关领域专家,经过多次讨论和修改,形成《肝细胞癌伴微血管侵犯诊断和治疗中国专家共识(2024版)》,以供国内同行参考。

Hepatocellular carcinoma (hereinafter referred to as liver cancer) is one of the most common malignant tumors in China. Surgical resection is the preferred treatment for liver cancer, but the postoperative recurrence and metastasis rates are quite high. Current evidence shows that microvascular invasion (MVI) is an independent risk factor for postoperative recurrence and metastasis of liver cancer, but there are still many controversies about the diagnosis, classification, prediction and treatment of MVI over the world. The Chinese Association of Liver Cancer of Chinese Medical Doctor Association organizes domestic experts in related fields to form the Chinese Expert Consensus on the Diagnosis and Treatment of Hepatocellular Carcinoma with Microvascular Invasion (2024 Edition) after many discussions and revisions, in order to better guide the diagnosis and treatment of liver cancer with MVI and for reference by domestic peers.

表1 证据评价与推荐意见分级、制定和评价证据质量与推荐强度分级
图1 常见的病理学检查标本取材方法 A:3点法;B:7点法;C:13点法;D:肝癌影像-数字化大体病理
[1]
Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73(1): 17-48.
[2]
Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma[J]. Semin Liver Dis, 2005, 25(2): 181-200.
[3]
Tabrizian P, Jibara G, Shrager B, et al. Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis[J]. Ann Surg, 2015, 261(5): 947-955.
[4]
Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: A retrospective, exploratory analysis[J]. Lancet Oncol, 2009, 10(1): 35-43.
[5]
Xu X, Lu D, Ling Q, et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria[J]. Gut, 2016, 65(6): 1035-1041.
[6]
Xu SL, Zhang YC, Wang GY, et al. Survival analysis of sirolimus-based immunosuppression in liver transplantation in patients with hepatocellular carcinoma[J]. Clin Res Hepatol Gastroenterol, 2016, 40(6): 674-681.
[7]
Duvoux C, Roudot-Thoraval F, Decaens T, et al. Liver transplantation for hepatocellular carcinoma: A model including α-fetoprotein improves the performance of Milan criteria[J]. Gastroenterology, 2012, 143(4): 986-994. e3.
[8]
Ryder SD. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults[J]. Gut, 2003, 52 (Suppl 3): iii1-8.
[9]
U.S. Preventive Services Task Force. Grade definitions and suggestions for practice[EB/OL]. Aviailable from:2012-10-12/2021-11-10.

URL    
[10]
Cong WM, Bu H, Chen J, et al. Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update[J]. World J Gastroenterol, 2016, 22(42): 9279-9287.
[11]
Altendorf-Hofmann A, Scheele J. Indication and surgical outcome in hepatocellular carcinoma with infiltration of blood vessels, bile ducts and lymph nodes[J]. Kongressbd Dtsch Ges Chir Kongr, 2002, 119: 635-641.
[12]
Cucchetti A, Piscaglia F, Grigioni AD, et al. Preoperative prediction of hepatocellular carcinoma tumour grade and micro-vascular invasion by means of artificial neural network: A pilot study[J]. J Hepatol, 2010, 52(6): 880-888.
[13]
Hung HH, Lei HJ, Chau GY, et al. Milan criteria, multi-nodularity, and microvascular invasion predict the recurrence patterns of hepatocellular carcinoma after resection[J]. J Gastrointest Surg, 2013, 17(4): 702-711.
[14]
Jun L, Zhenlin Y, Renyan G, et al. Independent factors and predictive score for extrahepatic metastasis of hepatocellular carcinoma following curative hepatectomy[J]. Oncologist, 2012, 17(7): 963-969.
[15]
Huang C, Zhu XD, Ji Y, et al. Microvascular invasion has limited clinical values in hepatocellular carcinoma patients at Barcelona Clinic Liver Cancer (BCLC) stages 0 or B[J]. BMC Cancer, 2017, 17(1): 58.
[16]
Imai K, Yamashita YI, Yusa T, et al. Microvascular invasion in small-sized hepatocellular carcinoma: significance for outcomes following hepatectomy and radiofrequency ablation[J]. Anticancer Res, 2018, 38(2): 1053-1060.
[17]
Li ZL, Yu JJ, Guo JW, et al. Liver resection is justified for multinodular hepatocellular carcinoma in selected patients with cirrhosis: A multicenter analysis of 1,066 patients[J]. Eur J Surg Oncol, 2019, 45(5): 800-807.
[18]
Shindoh J, Kobayashi Y, Kawamura Y, et al. Microvascular invasion and a size cutoff value of 2 cm predict long-term oncological outcome in multiple hepatocellular carcinoma: reappraisal of the American Joint Committee on Cancer Staging System and Validation Using the Surveillance, Epidemiology, and End-Results Database[J]. Liver Cancer, 2020, 9(2): 156-166.
[19]
Zhang XP, Zhou TF, Wang ZH, et al. Association of preoperative hypercoagulability with poor prognosis in hepatocellular carcinoma patients with microvascular invasion after liver resection: A multicenter study[J]. Ann Surg Oncol, 2019, 26(12): 4117-4125.
[20]
Sheng X, Ji Y, Ren GP, et al. A standardized pathological proposal for evaluating microvascular invasion of hepatocellular carcinoma: A multicenter study by LCPGC[J]. Hepatol Int, 2020, 14(6): 1034-1047.
[21]
Liu H, Yang Y, Chen C, et al. Reclassification of tumor size for solitary HBV-related hepatocellular carcinoma by minimum p value method: A large retrospective study[J]. World J Surg Oncol, 2020, 8(1): 185.
[22]
Lee S, Kim SH, Lee JE, et al. Preoperative gadoxetic acidenhanced MRI for predicting microvascular invasion in patients with single hepatocellular carcinoma[J]. J Hepatol, 2017, 67(3): 526-534.
[23]
Esnaola NF, Lauwers GY, Mirza NQ, et al. Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation[J]. J Gastrointest Surg, 2002, 6(2): 224-232.
[24]
Kim MJ, Lee M, Choi JY, et al. Imaging features of small hepatocellular carcinomas with microvascular invasion on gadoxetic acid-enhanced MR imaging[J]. Eur J Radiol, 2012, 81(10): 2507-2512.
[25]
Shindoh J, Andreou A, Aloia TA, et al. Microvascular invasion does not predict long-term survival in hepatocellular carcinoma up to 2 cm: reappraisal of the staging system for solitary tumors[J]. Ann Surg Oncol, 2013, 20(4): 1223-1229.
[26]
Yamashita YI, Imai K, Yusa T, et al. Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: predictors and optimal treatments[J]. Ann Gastroenterol Surg, 2018, 2(3): 197-203.
[27]
Bhattacharjya S, Bhattacharjya T, Quaglia A, et al. Liver transplantation in cirrhotic patients with small hepatocellular carcinoma: An analysis of pre-operative imaging, explant histology and prognostic histologic indicators[J]. Dig Surg, 2004, 21(2): 152-160.
[28]
Zhou JM, Zhou CY, Chen XP, et al. Anatomic resection improved the long-term outcome of hepatocellular carcinoma patients with microvascular invasion: A prospective cohort study[J]. World J Gastrointest Oncol, 2021, 13(12): 2190-2202.
[29]
Löhe F, Angele MK, Rentsch M, et al. Multifocal manifestation does not affect vascular invasion of hepatocellular carcinoma: implications for patient selection in liver transplantation[J]. Clin Transplant, 2007, 21(6): 696-701.
[30]
Nagano Y, Shimada H, Takeda K, et al. Predictive factors of microvascular invasion in patients with hepatocellular carcinoma larger than 5 cm[J]. World J Surg, 2008, 32(10): 2218-2222.
[31]
Kim JM, Kwon CH, Joh JW, et al. The effect of alkaline phosphatase and intrahepatic metastases in large hepatocellular carcinoma[J]. World J Surg Oncol, 2013, 11: 40.
[32]
Lim C, Mise Y, Sakamoto Y, et al. Above 5 cm, size does not matter anymore in patients with hepatocellular carcinoma[J]. World J Surg, 2014, 38(11): 2910-2908.
[33]
Kluger MD, Salceda JA, Laurent A, et al. Liver resection for hepatocellular carcinoma in 313 Western patients: tumor biology and underlying liver rather than tumor size drive prognosis[J]. J Hepatol, 2015, 62(5): 1131-1140.
[34]
Kim PT, Jang JH, Atenafu EG, et al. Outcomes after hepatic resection and subsequent multimodal treatment of recurrence for multifocal hepatocellular carcinoma[J]. Br J Surg, 2013, 100(11): 1516-1522.
[35]
Wang BW, Mok KT, Liu SI, et al. Is hepatectomy beneficial in the treatment of multinodular hepatocellular carcinoma?[J]. J Formos Med Assoc, 2008, 107(8): 616-626.
[36]
Goh BK, Chow PK, Teo JY, et al. Number of nodules, Child-Pugh status, margin positivity, and microvascular invasion, but not tumor size, are prognostic factors of survival after liver resection for multifocal hepatocellular carcinoma[J]. J Gastrointest Surg, 2014, 18(8): 1477-1485.
[37]
Wang H, Qian YW, Wu MC, et al. Liver resection is justified in patients with BCLC intermediate stage hepatocellular carcinoma without microvascular invasion[J]. J Gastrointest Surg, 2020, 24(12): 2737-2747.
[38]
Parfitt JR, Marotta P, Alghamdi M, et al. Recurrent hepatocellular carcinoma after transplantation: use of a pathological score on explanted livers to predict recurrence[J]. Liver Transpl, 2007, 13(4): 543-551.
[39]
Zheng J, Chou JF, Gönen M, et al. Prediction of hepatocellular carcinoma recurrence beyond Milan criteria after resection: validation of a clinical risk score in an international cohort[J]. Ann Surg, 2017, 266(4): 693-701.
[40]
Hwang YJ, Bae JS, Lee Y, et al. Classification of microvascular invasion of hepatocellular carcinoma: correlation with prognosis and magnetic resonance imaging[J]. Clin Mol Hepatol, 2023, 29(3): 733-746.
[41]
Sumie S, Nakashima O, Okuda K, et al. The significance of classifying microvascular invasion in patients with hepatocellular carcinoma[J]. Ann Surg Oncol, 2014, 21(3): 1002-1009.
[42]
Feng LH, Dong H, Lau WY, et al. Novel microvascular invasion-based prognostic nomograms to predict survival outcomes in patients after R0 resection for hepatocellular carcinoma[J]. J Cancer Res Clin Oncol, 2017, 143(2): 293-303.
[43]
Zhao H, Chen C, Fu X, et al. Prognostic value of a novel risk classification of microvascular invasion in patients with hepatocellular carcinoma after resection[J]. Oncotarget, 2017, 8(3): 5474-5486.
[44]
Roayaie S, Blume IN, Thung SN, et al. A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma[J]. Gastroenterology, 2009, 137(3): 850-855.
[45]
Chen L, Chen S, Zhou Q, et al. Microvascular invasion status and its survival impact in hepatocellular carcinoma depend on tissue sampling protocol[J]. Ann Surg Oncol, 2021, 28(11): 6747-6757.
[46]
Iguchi T, Shirabe K, Aishima S, et al. New pathologic stratification of microvascular invasion in hepatocellular carcinoma: predicting prognosis after living-donor liver transplantation[J]. Transplantation, 2015, 99(6): 1236-1242.
[47]
Xu XF, Diao YK, Zeng YY, et al. Association of severity in the grading of microvascular invasion with long-term oncological prognosis after liver resection for early-stage hepatocellular carcinoma: A multicenter retrospective cohort study from a hepatitis B virus-endemic area[J]. Int J Surg, 2023, 109(4): 841-849.
[48]
Yu HM, Wang K, Feng JK, et al. Image-matching digital macro-slide-a novel pathological examination method for microvascular invasion detection in hepatocellular carcinoma[J]. Hepatol Int, 2022, 16(2): 381-395.
[49]
Sun L, Sun Z, Wang C, et al. PCformer: An MVI recognition method via classification of the MVI boundary according to histopathological images of liver cancer[J]. J Opt Soc Am A Opt Image Sci Vis, 2022, 39(9): 1673-1681.
[50]
Zhang XP, Wang K, Wei XB, et al. An eastern hepatobiliary surgery hospital microvascular invasion scoring system in predicting prognosis of patients with hepatocellular carcinoma and microvascular invasion after R0 liver resection: A large-scale, multicenter study[J]. Oncologist, 2019, 24(12): e1476-e1488.
[51]
Wang K, Xiang YJ, Yu HM, et al. A novel classification in predicting prognosis and guiding postoperative management after R0 liver resection for patients with hepatocellular carcinoma and microvascular invasion[J]. Eur J Surg Oncol, 2022, 48(6): 1348-1355.
[52]
Zhou J, Zhang Z, Zhou H, et al. Preoperative circulating tumor cells to predict microvascular invasion and dynamical detection indicate the prognosis of hepatocellular carcinoma[J]. BMC Cancer, 2020, 20(1): 1047.
[53]
Li H, Li T, Hu J, et al. A nomogram to predict microvascular invasion in early hepatocellular carcinoma[J]. J Cancer Res Ther, 2021, 17(3): 652-657.
[54]
Wei J, Jiang H, Zeng M, et al. Prediction of microvascular invasion in hepatocellular carcinoma via deep learning: A multicenter and prospective validation study[J]. Cancers (Basel), 2021, 13(10): 2368.
[55]
Song L, Li J, Luo Y. The importance of a nonsmooth tumor margin and incomplete tumor capsule in predicting HCC microvascular invasion on preoperative imaging examination: A systematic review and meta-analysis[J]. Clin Imaging, 2021, 76: 77-82.
[56]
Hong SB, Choi SH, Kim SY, et al. MRI features for predicting microvascular invasion of hepatocellular carcinoma: A systematic review and meta-analysis[J]. Liver Cancer, 2021, 10(2): 94-106.
[57]
Xu X, Zhang HL, Liu QP, et al. Radiomic analysis of contrast-enhanced CT predicts microvascular invasion and outcome in hepatocellular carcinoma[J]. J Hepatol, 2019, 70(6): 1133-1144.
[58]
Zhang K, Zhang L, Li WC, et al. Radiomics nomogram for the prediction of microvascular invasion of HCC and patients’ benefit from postoperative adjuvant TACE: A multicenter study[J]. Eur Radiol, 2023, 33(12): 8936-8947.
[59]
Xiao Q, Zhu W, Tang H, et al. Ultrasound radiomics in the prediction of microvascular invasion in hepatocellular carcinoma: A systematic review and meta-analysis[J]. Heliyon, 2023, 9(6): e16997.
[60]
Wang Z, Cao L, Wang J, et al. A novel predictive model of microvascular invasion in hepatocellular carcinoma based on differential protein expression[J]. BMC Gastroenterol, 2023, 23(1): 89.
[61]
Banerjee S, Wang DS, Kim HJ, et al. A computed tomography radiogenomic biomarker predicts microvascular invasion and clinical outcomes in hepatocellular carcinoma[J]. Hepatology, 2015, 62(3): 792-800.
[62]
Xin Z, Li J, Zhang H, et al. Cancer genomic alterations can be potential biomarkers predicting microvascular invasion and early recurrence of hepatocellular carcinoma[J]. Front Oncol, 2022, 12: 783109.
[63]
Lei Z, Li J, Wu D, et al. Nomogram for preoperative estimation of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma within the Milan criteria[J]. JAMA Surg, 2016, 151(4): 356-363.
[64]
Lee S, Kang TW, Song KD, et al. Effect of microvascular invasion risk on early recurrence of hepatocellular carcinoma after surgery and radiofrequency ablation[J]. Ann Surg, 2021, 273(3): 564-571.
[65]
Liu W, Zhang L, Xin Z, et al. A Promising preoperative prediction model for microvascular invasion in hepatocellular carcinoma based on an extreme gradient boosting algorithm[J]. Front Oncol, 2022, 12: 852736.
[66]
Sun SW, Liu QP, Xu X, et al. Direct comparison of four presurgical stratifying schemes for prediction of microvascular invasion in hepatocellular carcinoma by gadoxetic acidenhanced MRI[J]. J Magn Reson Imaging, 2020, 52(2): 433-447.
[67]
Bai S, Yang P, Xie Z, et al. Preoperative estimated risk of microvascular invasion is associated with prognostic differences following liver resection versus radiofrequency ablation for early hepatitis B virus-related hepatocellular carcinoma[J]. Ann Surg Oncol, 2021, 28(13): 8174-8185.
[68]
Imai K, Yamashita YI, Yusa T, et al. Microvascular invasion in small-sized hepatocellular carcinoma: significance for outcomes following hepatectomy and radiofrequency ablation[J]. Anticancer Res, 2018, 38(2): 1053-1060.
[69]
Yang P, Teng F, Bai S, et al. Liver resection versus liver transplantation for hepatocellular carcinoma within the Milan criteria based on estimated microvascular invasion risks[J]. Gastroenterol Rep (Oxf), 2023, 11: goad035.
[70]
Chan SC, Fan ST, Chok KS, et al. Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion[J]. Hepatol Int, 2012, 6(3): 646-656.
[71]
Vitale A, Huo TL, Cucchetti A, et al. Survival benefit of liver transplantation versus resection for hepatocellular carcinoma: impact of MELD score[J]. Ann Surg Oncol, 2015, 22(6): 1901-1907.
[72]
Jeong J, Park JG, Seo KI, et al. Microvascular invasion may be the determining factor in selecting TACE as the initial treatment in patients with hepatocellular carcinoma[J]. Medicine (Baltimore), 2021, 100(27): e26584.
[73]
Yang Y, Dang Z, Lu P, et al. Impact of pathological response after preoperative transcatheter arterial chemoembolization (TACE) on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma: A multicenter propensity score matching analysis[J]. Hepatobiliary Surg Nutr, 2022, 11(3): 386-399.
[74]
Yang Y, Lin K, Liu L, et al. Impact of preoperative TACE on incidences of microvascular invasion and long-term post-hepatectomy survival in hepatocellular carcinoma patients: A propensity score matching analysis[J]. Cancer Med, 2021, 10(6): 2100-2111.
[75]
Kim JM, Kwon CH, Joh JW, et al. Effectiveness of locoregional therapy before living donor liver transplantation in patients with hepatocellular carcinoma who meet the Milan criteria[J]. Transplant Proc, 2012, 44(2): 403-408.
[76]
Wei X, Jiang Y, Feng S, et al. Neoadjuvant intensity modulated radiotherapy for a single and small (≤ 5 cm) hepatitis B virus-related hepatocellular carcinoma predicted to have high risks of microvascular invasion: A randomized clinical trial[J]. Int J Surg, 2023, 109(10): 3052-3060.
[77]
Zheng J, Wang N, Yuan J, et al. The appropriate method of hepatectomy for hepatocellular carcinoma within University of California San Francisco (UCSF) criteria through neural network analysis[J]. HPB (Oxford), 2023, 25(5): 497-506.
[78]
Hirose Y, Sakata J, Takizawa K, et al. Impact of anatomic resection on long-term survival in patients with hepatocellular carcinoma with T1-T2 disease or microscopic vascular invasion[J]. Surg Oncol, 2023, 49: 101951.
[79]
Meng XP, Tang TY, Ding ZM, et al. Preoperative microvascular invasion prediction to assist in surgical plan for single hepatocellular carcinoma: better together with radiomics[J]. Ann Surg Oncol, 2022, 29(5): 2960-2970.
[80]
Hu H, Qi S, Zeng S, et al. Importance of microvascular invasion risk and tumor size on recurrence and survival of hepatocellular carcinoma after anatomical resection and nonanatomical resection[J]. Front Oncol, 2021, 11: 621622.
[81]
Shi C, Zhao Q, Liao B, et al. Anatomic resection and wide resection margin play an important role in hepatectomy for hepatocellular carcinoma with peritumoural micrometastasis[J]. ANZ J Surg, 2019, 89(11): E482-E486.
[82]
Zhong XP, Zhang YF, Mei J, et al. Anatomical versus nonanatomical resection for hepatocellular carcinoma with microscope vascular invasion: A propensity score matching analysis[J]. J Cancer, 2019, 10(17): 3950-3957.
[83]
Lin S, Ye F, Rong W, et al. Nomogram to assist in surgical plan for hepatocellular carcinoma: A prediction model for microvascular invasion[J]. J Gastrointest Surg, 2019, 23(12): 2372-2382.
[84]
Liu J, Zhu Q, Li Y, et al. Microvascular invasion and positive HB e antigen are associated with poorer survival after hepatectomy of early hepatocellular carcinoma: A retrospective cohort study[J]. Clin Res Hepatol Gastroenterol, 2018, 42(4): 330-338.
[85]
Yamashita YI, Imai K, Yusa T, et al. Microvascular invasion of single small hepatocellular carcinoma ≤ 3 cm: predictors and optimal treatments[J]. Ann Gastroenterol Surg, 2018, 2(3): 197-203.
[86]
Zhao H, Hua Y, Lu Z, et al. Prognostic value and preoperative predictors of microvascular invasion in solitary hepatocellular carcinoma ≤ 5 cm without macrovascular invasion[J]. Oncotarget, 2017, 8(37): 61203-61214.
[87]
Cucchetti A, Qiao GL, Cescon M, et al. Anatomic versus nonanatomic resection in cirrhotic patients with early hepatocellular carcinoma[J]. Surgery, 2014, 155(3): 512-521.
[88]
Fan LF, Zhao WC, Yang N, et al. Alpha-fetoprotein: the predictor of microvascular invasion in solitary small hepatocellular carcinoma and criterion for anatomic or non-anatomic hepatic resection[J]. Hepatogastroenterology, 2013, 60(124): 825-836.
[89]
Chen ZH, Zhang XP, Feng JK, et al. Actual long-term survival in hepatocellular carcinoma patients with microvascular invasion: A multicenter study from China[J]. Hepatol Int, 2021, 15(3): 642-650.
[90]
Yang SY, Yan ML, Duan YF, et al. Perioperative and long-term survival outcomes of laparoscopic versus laparotomic hepatectomy for BCLC stages 0-A hepatocellular carcinoma patients associated with or without microvascular invasion: A multicenter, propensity score matching analysis[J]. Hepatol Int, 2022, 16(4): 892-905.
[91]
Wang J, Wang W, Wang H, et al. Physiological and pathological functions of SLC26A6[J]. Front Med (Lausanne), 2020, 7: 618256.
[92]
Han J, Li ZL, Xing H, et al. The impact of resection margin and microvascular invasion on long-term prognosis after curative resection of hepatocellular carcinoma: A multiinstitutional study[J]. HPB (Oxford), 2019, 21(8): 962-971.
[93]
Yang P, Si A, Yang J, et al. A wide-margin liver resection improves long-term outcomes for patients with HBV-related hepatocellular carcinoma with microvascular invasion[J]. Surgery, 2019, 165(4): 721-730.
[94]
Liu M, Wang L, Zhu H, et al. A preoperative measurement of serum microRNA-125b may predict the presence of microvascular invasion in hepatocellular carcinomas patients[J]. Transl Oncol, 2016, 9(3): 167-172.
[95]
Liu J, Zhuang G, Bai S, et al. The comparison of surgical margins and type of hepatic resection for hepatocellular carcinoma with microvascular invasion[J]. Oncologist, 2023, 28(11): e1043-e1051.
[96]
Zhang XP, Xu S, Lin ZY, et al. Significance of anatomical resection and resection margin status in patients with HBV-related hepatocellular carcinoma and microvascular invasion: A multicenter propensity score-matched study[J]. Int J Surg, 2023, 109(4): 679-688.
[97]
Zhou JM, Zhou CY, Chen XP, et al. Anatomic resection improved the long-term outcome of hepatocellular carcinoma patients with microvascular invasion: A prospective cohort study[J]. World J Gastrointest Oncol, 2021, 13(12): 2190-2202.
[98]
Shi F, Zhou Z, Huang X, et al. Is anatomical resection necessary for early hepatocellular carcinoma? A single institution retrospective experience[J]. Future Oncol, 2019, 15(17): 2041-2051.
[99]
Shin S, Kim TS, Lee JW, et al. Is the anatomical resection necessary for single hepatocellular carcinoma smaller than 3 cm?: single-center experience of liver resection for a small HCC[J]. Ann Hepatobiliary Pancreat Surg, 2018, 22 (4): 326-334.
[100]
Zhou Q, Zhou C, Yin Y, et al. Development and validation of a nomogram combining hematological and imaging features for preoperative prediction of microvascular invasion in hepatocellular carcinoma patients[J]. Ann Transl Med, 2021, 9(5): 402.
[101]
Wang L, Liu Y, Rong W, et al. The role of intraoperative electron radiotherapy in centrally located hepatocellular carcinomas treated with narrow-margin (<1 cm) hepatectomy: A prospective, phase 2 study[J]. Hepatobiliary Surg Nutr, 2022, 11(4): 515-529.
[102]
Wang Z, Duan Y, Zhang J, et al. Preoperative antiviral therapy and microvascular invasion in hepatitis B virus-related hepatocellular carcinoma: A meta-analysis[J]. Eur J Pharmacol, 2020, 883: 173382.
[103]
Qu C, Huang X, Liu K, et al. Effect of hepatitis B virus DNA replication level and anti-HBV therapy on microvascular invasion of hepatocellular carcinoma[J]. Infect Agent Cancer, 2019, 14: 2.
[104]
Liu K, Duan J, Liu H, et al. Precancer antiviral treatment reduces microvascular invasion of early-stage hepatitis B-related hepatocellular carcinoma[J]. Sci Rep, 2019, 9(1): 2220.
[105]
Tang Y, Zhang J, Chen G, et al. Efficacy of adjuvant transarterial chemoembolization combined antiviral therapy for HBV-related HCC with MVI after hepatic resection: A multicenter study[J]. Asian Pac J Cancer Prev, 2022, 23(8): 2695-2703.
[106]
Kong J, Liang X, Zhang J, et al. Antiviral therapy improves survival in hepatocellular carcinoma with microvascular invasion: A propensity score analysis[J]. Dig Dis Sci, 2022, 67(8): 4250-4257.
[107]
Li L, Li B, Zhang M. HBV DNA levels impact the prognosis of hepatocellular carcinoma patients with microvascular invasion[J]. Medicine (Baltimore), 2019, 98(27): e16308.
[108]
Wang Z, Duan Y, Zhang J, et al. Preoperative antiviral therapy and microvascular invasion in hepatitis B virus-related hepatocellular carcinoma: A meta-analysis[J]. Eur J Pharmacol, 2020, 883: 173382.
[109]
Li Z, Lei Z, Xia Y, et al. Association of preoperative antiviral treatment with incidences of microvascular invasion and early tumor recurrence in hepatitis B virus-related hepatocellular carcinoma[J]. JAMA Surg, 2018, 153(10): e182721.
[110]
Sun JJ, Wang K, Zhang CZ, et al. Postoperative adjuvant trans-catheter arterial chemoembolization after R0 hepatectomy improves outcomes of patients who have hepatocellular carcinoma with microvascular invasion[J]. Ann Surg Oncol, 2016, 23(4): 1344-1351.
[111]
Wei W, Jian PE, Li SH, et al. Adjuvant transcatheter arterial chemoembolization after curative resection for hepatocellular carcinoma patients with solitary tumor and microvascular invasion: A randomized clinical trial of efficacy and safety[J]. Cancer Commun (Lond), 2018, 38(1): 61.
[112]
Mo A, Lin B, Chen D. Efficacy of sequential TACE on primary hepatocellular carcinoma with microvascular invasion after radical resection: A systematic review and meta-analysis[J]. World J Surg Oncol, 2023, 21(1): 277.
[113]
Liu ZH, Chai ZT, Feng JK, et al. A reasonable identification of the early recurrence time based on microvascular invasion for hepatocellular carcinoma after R0 resection: A multicenter retrospective study[J]. Cancer Med, 2023, 12(9): 10294-10302.
[114]
Chen ZH, Zhang XP, Zhou TF, et al. Adjuvant transarterial chemoembolization improves survival outcomes in hepatocellular carcinoma with microvascular invasion: A systematic review and meta-analysis[J]. Eur J Surg Oncol, 2019, 45(11): 2188-2196.
[115]
Ye JZ, Chen JZ, Li ZH, et al. Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion[J]. World J Gastroenterol, 2017, 23(41): 7415-7424.
[116]
Luo L, Shan R, Cui L, et al. Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort[J]. United European Gastroenterol J, 2023, 11(2): 228-241.
[117]
Gao Z, Du G, Pang Y, et al. Adjuvant transarterial chemoem-bolization after radical resection contributed to the outcomes of hepatocellular carcinoma patients with high-risk factors[J]. Medicine (Baltimore), 2017, 96(33): e7426.
[118]
Shi C, Li Y, Geng L, et al. Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with microvascular invasion: A randomised controlled trial[J]. Eur J Cancer, 2022, 166: 176-184.
[119]
Wang L, Wang W, Rong W, et al. Postoperative adjuvant treatment strategy for hepatocellular carcinoma with microvascular invasion: A non-randomized interventional clinical study[J]. BMC Cancer, 2020, 20(1): 614.
[120]
Wang L, Wang W, Yao X, et al. Postoperative adjuvant radiotherapy is associated with improved survival in hepatocellular carcinoma with microvascular invasion[J]. Oncotarget, 2017, 8(45): 79971-79981.
[121]
Wang L, Chen B, Li Z, et al. Optimal postoperative adjuvant treatment strategy for HBV-related hepatocellular carcinoma with microvascular invasion: A propensity score analysis[J]. Onco Targets Ther, 2019, 12: 1237-1247.
[122]
Li SH, Mei J, Cheng Y, et al. Postoperative adjuvant hepatic arterial infusion chemotherapy with FOLFOX in hepatocellular carcinoma with microvascular invasion: A multicenter, phase Ⅲ, randomized study[J]. J Clin Oncol, 2023, 41(10): 1898-1908.
[123]
Hu L, Zheng Y, Lin J, et al. Does adjuvant hepatic artery infusion chemotherapy improve patient outcomes for hepatocellular carcinoma following liver resection? A meta-analysis[J]. World J Surg Oncol, 2023, 21(1): 121.
[124]
Pinyol R, Montal R, Bassaganyas L, et al. Molecular predictors of prevention of recurrence in HCC with Sorafenib as adjuvant treatment and prognostic factors in the phase 3 STORM trial[J]. Gut, 2019, 68(6): 1065-1075.
[125]
Huang Y, Zhang Z, Zhou Y, et al. Should we apply Sorafenib in hepatocellular carcinoma patients with microvascular invasion after curative hepatectomy?[J]. Onco Targets Ther, 2019, 12: 541-548.
[126]
Zhang XP, Chai ZT, Gao YZ, et al. Postoperative adjuvant Sorafenib improves survival outcomes in hepatocellular carcinoma patients with microvascular invasion after R0 liver resection: A propensity score matching analysis[J]. HPB (Oxford), 2019, 21(12): 1687-1696.
[127]
Gu W, Tong Z. Sorafenib in the treatment of patients with hepatocellular carcinoma (HCC) and microvascular infiltration: A systematic review and meta-analysis[J]. J Int Med Res, 2020, 48(8): 300060520946872.
[128]
Bai S, Hu L, Liu J, et al. Prognostic nomograms combined adjuvant Lenvatinib for hepatitis B virus-related hepatocellular carcinoma with microvascular invasion after radical resection[J]. Front Oncol, 2022, 12: 919824.
[129]
Dai MG, Liu SY, Lu WF, et al. Survival benefits from adjuvant Lenvatinib for patients with hepatocellular carcinoma and microvascular invasion after curative hepatectomy[J]. Clin Med Insights Oncol, 2023, 17: 11795549231180351.
[130]
Qin S, Chen M, Cheng AL, et al. Atezolizumab plus Bevacizumab versus active surveillance in patients with resected or ablated high-risk hepatocellular carcinoma (IMbrave050): A randomised, open-label, multicentre, phase 3 trial[J]. Lancet, 2023, 402(10415): 1835-1847.
[131]
Wang K, Xiang YJ, Yu HM, et al. Adjuvant Sintilimab in resected high-risk hepatocellular carcinoma: A randomized, controlled, phase 2 trial[J]. Nat Med, 2024[2024-01-25].

URL    
[132]
Yang Y, Sun J, Wu M, et al. Chinese expert consensus on immunotherapy for hepatocellular carcinoma (2021 edition)[J]. Liver Cancer, 2022, 11(6): 511-526.
[133]
中国医师协会肝癌专业委员会. 肝细胞癌分子靶向药物临床应用中国专家共识(2020版)[J]. 中华医学杂志, 2021, 101 (28): 2185-2194.
[134]
Feng W, Cao W, Cui C, et al. Efficacy of lipid nanoparticle-loaded Sorafenib combined with hepatic artery chemoem-bolization in the treatment of primary hepatocellular carcinoma complicated with microvascular invasion[J]. Dis Markers, 2022, 2022: 4996471.
[135]
Wu J, Sun H, Han Z, et al. A single center experience: posttransplantation adjuvant chemotherapy impacts the prognosis of hepatocellular carcinoma patients[J]. Chin Med J (Engl), 2014, 127(3): 430-434.
[136]
Oh N, Rhu J, Kim JM, et al. Improved recurrence-free survival in patients with HCC with post-transplant plasma exchange[J]. Liver Transpl, 2023, 29(8): 804-812.
[137]
Kow AW, Kwon CH, Song S, et al. Risk factors of peritoneal recurrence and outcome of resected peritoneal recurrence after liver resection in hepatocellular carcinoma: review of 1 222 cases of hepatectomy in a tertiary institution[J]. Ann Surg Oncol, 2012, 19(7): 2246-2255.
[138]
Li J, Liu Y, Yan Z, et al. A nomogram predicting pulmonary metastasis of hepatocellular carcinoma following partial hepatectomy[J]. Br J Cancer, 2014, 110(5): 1110-1117.
[139]
Ali MA, Li WF, Wang JH, et al. Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan[J]. HPB (Oxford), 2016, 18(10): 851-860.
[140]
Ryu T, Takami Y, Wada Y, et al. Efficacy of surgical microwave ablation for recurrent hepatocellular carcinoma after curative hepatectomy[J]. HPB (Oxford), 2020, 22(3): 461-469.
[141]
Chen SL, Xiao H, Xie ZL, et al. The presence of microvascular invasion guides treatment strategy in recurrent HBV-related HCC[J]. Eur Radiol, 2020, 30(6): 3473-3485.
[142]
Jin YJ, Lee JW, Lee OH, et al. Transarterial chemoembolization versus surgery/radiofrequency ablation for recurrent hepatocellular carcinoma with or without microvascular invasion[J]. J Gastroenterol Hepatol, 2014, 29(5): 1056-1064.
[143]
Xiao H, Chen ZB, Jin HL, et al. Treatment selection of recurrent hepatocellular carcinoma with microvascular invasion at the initial hepatectomy[J]. Am J Transl Res, 2019, 11(3): 1864-1875.
[144]
Wen T, Jin C, Facciorusso A, et al. Multidisciplinary management of recurrent and metastatic hepatocellular carcinoma after resection: An international expert consensus[J]. Hepatobiliary Surg Nutr, 2018, 7(5): 353-371.
[145]
Peng Z, Wu X, Li J, et al. The role of neoadjuvant conventional transarterial chemoembolization with radiofrequency ablation in the treatment of recurrent hepatocellular carcinoma after initial hepatectomy with microvascular invasion[J]. Int J Hyperthermia, 2022, 39(1): 688-696.
[146]
Sun X, Yang Z, Mei J, et al. The guiding value of microvascular invasion for treating early recurrent small hepatocellular carcinoma[J]. Int J Hyperthermia, 2021, 38(1): 931-938.
[147]
Wei MC, Zhang YJ, Chen MS, et al. Adjuvant Sorafenib following radiofrequency ablation for early-stage recurrent hepatocellular carcinoma with microvascular invasion at the initial hepatectomy[J]. Front Oncol, 2022, 12: 868429.
[148]
Peng Z, Chen S, Xiao H, et al. Microvascular invasion as a predictor of response to treatment with Sorafenib and transarterial chemoembolization for recurrent intermediate-stage hepatocellular carcinoma[J]. Radiology, 2019, 292(1): 237-247.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[2] 仲卫冬, 胡根, 邵国益. 腹腔开放合并肠空气瘘的管理[J]. 中华损伤与修复杂志(电子版), 2024, 19(05): 462-462.
[3] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[4] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
[5] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[6] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
[7] 王宇, 徐芳泉, 周旋, 姚晓峰, 李强. 不断提高分化型甲状腺癌根治性切除规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 473-476.
[8] 吴伟宙, 王琼仁, 詹雄宇, 郑明星, 李亚县. 广东省医学会泌尿外科疑难病例多学科会诊(第16期)——左肾肉瘤样癌[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 525-529.
[9] 梁艳娉, 陈燕柔, 梁运啸, 白飞虎, 吴斌, 王省. 华南地区门静脉高压食管胃静脉曲张出血内镜治疗现状调研分析[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 390-395.
[10] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[11] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
[12] 王昌前, 林婷婷, 宁雨露, 王颖杰, 谭文勇. 光免疫治疗在肿瘤领域的临床应用新进展[J]. 中华临床医师杂志(电子版), 2024, 18(06): 575-583.
[13] 奚培培, 周加军. 慢性肾脏病患者肌少症机制和诊治的研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(05): 491-495.
[14] 温绍敏, 王雅晳, 施依璐, 段莎莎, 云书荣, 张小杉. 靶向超声造影技术在动脉粥样硬化治疗中的应用进展[J]. 中华临床医师杂志(电子版), 2024, 18(05): 496-499.
[15] 孙双权, 孙玮玮, 王勇, 方道成, 温晖. 肾脏混合性上皮和间质肿瘤一例[J]. 中华临床医师杂志(电子版), 2024, 18(05): 512-515.
阅读次数
全文


摘要