中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (04): 450-456.DOI: 10.19538/j.cjps.issn1005-2208.2025.04.12

• 论著 • 上一篇    下一篇

肿瘤出芽对微血管侵犯阴性肝细胞癌病人预后预测价值及术后辅助治疗效果评价

杨凯博1，贾    非1，杨泽荣1，唐卓人1，吴坤瑾1，万    永2，常虎林3，曲    凯1   

  1. 1西安交通大学第二附属医院肝胆胰与肝移植外科，陕西西安 710002；2西安交通大学第一附属医院腹部外科（老年外科），陕西西安 710061；3陕西省人民医院肝胆外科，陕西西安 710068
  • 出版日期:2025-04-01 发布日期:2025-04-30

  • Online:2025-04-01 Published:2025-04-30

摘要： 目的    评估肿瘤出芽（TB）对微血管侵犯（MVI）阴性肝细胞癌（HCC）病人的预后预测价值，并探讨术后辅助酪氨酸激酶抑制剂（TKI）治疗和预防性动脉化疗栓塞术（TACE）对TB阳性病人预后的影响。方法    回顾性分析2016—2020年西安交通大学第一附属医院、西安交通大学第二附属医院、陕西省人民医院收治的行根治性肝切除术的186例MVI阴性HCC病人的临床资料。通过病理和免疫组化检查对TB进行评估，采用Cox比例风险模型分析预后影响因素，并通过Kaplan-Meier生存曲线比较术后辅助治疗对TB阳性亚组的生存获益。随访时间截至2022-06-01。结果    85例（45.6%）病人TB阳性。多因素Cox回归分析显示，肿瘤T分期（HR=1.617，95%CI 1.157-2.260，P=0.005）、术前甲胎蛋白（AFP）＞400 μg/L（HR=2.255，95%CI 1.294-3.928，P=0.004）、肿瘤长径>5 cm（HR=3.529，95%CI 1.311-9.411，P=0.011）是总体生存率（OS）的独立危险因素；TB阳性（HR=2.763，95%CI 1.687-4.526，P<0.001）、肿瘤多发（HR=7.031，95%CI 1.751-28.229，P=0.006）、肿瘤长径>5 cm（HR=2.748，95%CI 1.343-5.623，P=0.06）是无复发生存率（RFS）的独立危险因素。TB阳性病人接受术后辅助TKI治疗或预防性TACE并未改善OS和RFS。结论    TB是影响MVI阴性HCC病人预后的独立危险因素，能够作为MVI的重要补充；对于MVI阴性、TB阳性的肝细胞癌病人，术后辅助TKI治疗或预防性TCAE治疗未能改善预后。

关键词: 肝细胞癌, 肿瘤出芽, 微血管侵犯, 酪氨酸激酶抑制剂, 动脉化疗栓塞术

Abstract: To evaluate the prognostic value of tumor budding (TB) in patients with microvascular invasion (MVI) negative hepatocellular carcinoma (HCC) and to explore the impact of postoperative adjuvant therapy with tyrosine kinase inhibitors (TKI) and prophylactic transarterial chemoembolization (TACE) on the prognosis of TB-positive patients. Methods    A retrospective analysis was conducted on the clinical data of 186 MVI-negative HCC patients who underwent curative surgery at the First Affiliated Hospital of Xi'an Jiaotong University, the Second Affiliated Hospital of Xi'an Jiaotong University, and Shaanxi Provincial People's Hospital between 2016 and 2020. TB was assessed through pathological and immunohistochemical examinations. The Cox proportional hazards model was used to analyze prognostic factors, and Kaplan-Meier survival curves were employed to compare the survival benefits of postoperative adjuvant therapies in the TB-positive subgroup. Follow-up was conducted until June 1, 2022. Results    Among the patients, 85 (45.6%) were TB-positive. Multivariate Cox regression analysis revealed that tumor T stage (HR=1.617, 95% CI 1.157-2.260, P=0.005), preoperative AFP levels >400 µg/L (HR=2.255, 95% CI 1.294-3.928, P=0.004), and tumor diameter >5 cm (HR=3.529, 95% CI 1.311-9.411, P=0.011) were independent risk factors for overall survival (OS). TB positivity (HR=2.763, 95% CI 1.687-4.526, P<0.001), tumor multiplicity (HR=7.031, 95% CI 1.751-28.229, P=0.006), and tumor diameter >5 cm (HR=2.748, 95% CI 1.343-5.623, P=0.06) were independent risk factors for recurrence-free survival (RFS). The subgroup analysis of TB-positive patients indicated that postoperative treatment with TKI and prophylactic TACE did not improve RFS or OS. Conclusion    TB serves as an independent prognostic indicator for assessing recurrence risk in MVI-negative hepatocellular carcinoma patients and an important supplement to MVI. For TB-positive patients, the current postoperative adjuvant treatment strategies (TKI/TACE) did not demonstrate a significant improvement in prognosis, highlighting the need for exploring treatment strategies with better target abilities.

Key words: hepatocellular carcinoma, tumor budding, microvascular invasion, tyrosine kinase inhibitors, transarterial chemoembolization