肝细胞癌肿瘤包膜与治疗决策及预后关系的研究进展

Tumor capsule in hepatocellular carcinoma: implications for treatment decision-making and prognostic stratification

摘要:

肝细胞癌（HCC）是全球癌症相关死亡的重要原因之一。近年来研究表明，肿瘤包膜作为HCC的经典病理特征，在疾病侵袭性评估、治疗策略制定及预后分层中具有重要临床价值。术前主要依赖影像学评估包膜状态，组织病理学仍为诊断金标准。根据完整性可分为完整、不完整及缺失三类。完整包膜可作为物理屏障限制肿瘤浸润，显著降低微血管侵犯风险，是术前预测侵袭性的重要影像学标志。在外科治疗中，包膜完整者在保证切缘阴性的前提下可考虑窄切缘策略以保留功能性肝实质，而包膜不完整或缺失者则需扩大切缘。在非手术治疗方面，包膜完整与经肝动脉化疗栓塞疗效、放疗局部控制及系统治疗预后密切相关，可能涉及肿瘤微环境、血流动力学及分子信号通路等机制。作为连接肿瘤生物学特征与治疗决策的重要桥梁，肿瘤包膜在HCC精准分层治疗中仍具有广阔的研究前景。

Abstract:

Hepatocellular carcinoma (HCC), a leading cause of cancer-related mortality worldwide, demonstrates marked heterogeneity in biological behavior and therapeutic response. Emerging evidence indicates that tumor capsule integrity, a classical histopathological feature, plays a pivotal role in risk stratification and treatment decision-making. Preoperative assessment primarily relies on imaging modalities, whereas histopathology remains the gold standard. According to structural integrity, the capsule can be categorized as complete, incomplete, or absent. An intact capsule functions as a physical barrier that limits tumor invasion and is closely associated with a lower incidence of microvascular invasion. In surgical management, narrow-margin resection may be considered in capsule-intact tumors when negative margins are secured, whereas wider margins are recommended for tumors with incomplete or absent capsules. Beyond surgery, capsule integrity has been correlated with therapeutic response to transarterial chemoembolization, radiotherapy, and systemic therapies, potentially through mechanisms involving tumor hemodynamics, microenvironmental modulation, and oncogenic signaling pathways as a bridge linking tumor biology with therapeutic strategies. Tumor capsule status warrants further investigation in the era of precision medicine.