Li Zhenli, Xu Lindi, Zhu Shuaishuai, Qi Xingshun, Zhang Wei, Tang Yufu
Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang, China.
Department of General Surgery, The 963rd Hospital of the Joint Service Support Force of the PLA, Jiamusi, China.
J Cell Mol Med. 2025 Aug;29(15):e70746. doi: 10.1111/jcmm.70746.
Liver resection remains the mainstay curative treatment for hepatocellular carcinoma (HCC); however, the recurrence rate is reported to exceed 70% within 5 years after surgery. Microvascular invasion (MVI) has attracted great research interest in the last decade and has been confirmed to be an independent risk factor for postoperative recurrence and survival. Presently, the diagnosis of MVI depends on pathological specimens, which are not helpful in guiding preoperative planning and intraoperative decision-making. However, preoperative MVI prediction has developed rapidly with the widespread application of predictive models. Besides the well-defined clinical predictive factors, radiomics and artificial intelligence (AI)-based models can provide accurate predictions of MVI. In terms of the specific management of MVI, multiple pre- and intraoperative therapeutic choices have shown favourable effects in patients at high risk of MVI indicated by predictive models. Several postoperative adjuvant therapies were also demonstrated to be associated with improved surgical outcomes in patients diagnosed with MVI. Considering that the present perspectives concerning MVI-related management are still controversial, based on the latest research, the present paper provides updated insights into the 1) diagnosis and classification of MVI, 2) the predictive factors and models of MVI and 3) effective therapeutic choices of MVI in pre-, intra- and postoperative processes. The remaining challenges in the management of MVI are highlighted to stimulate further explorations of the precise and individualised management of MVI.
肝切除术仍然是肝细胞癌（HCC）的主要根治性治疗方法；然而，据报道，术后5年内复发率超过70%。微血管侵犯（MVI）在过去十年中引起了极大的研究兴趣，并已被证实是术后复发和生存的独立危险因素。目前，MVI的诊断依赖于病理标本，这对术前规划和术中决策并无帮助。然而，随着预测模型的广泛应用，术前MVI预测发展迅速。除了明确的临床预测因素外，基于影像组学和人工智能（AI）的模型也能对MVI进行准确预测。在MVI的具体管理方面，多种术前和术中治疗选择已在预测模型显示的MVI高风险患者中显示出良好效果。一些术后辅助治疗也被证明与诊断为MVI的患者手术效果改善相关。鉴于目前关于MVI相关管理的观点仍存在争议，基于最新研究，本文对以下方面提供了最新见解：1）MVI的诊断和分类；2）MVI的预测因素和模型；3）术前、术中和术后MVI的有效治疗选择。强调了MVI管理中仍然存在的挑战，以激发对MVI精确个体化管理的进一步探索。
