原发性肝细胞肝癌患者外周血指标的临床价值及其应用前景

doi:10.3969/j.issn.1673-8640.2025.04.001

摘要/Abstract

摘要：

原发性肝癌是发病率和死亡率均排名前列的恶性肿瘤，肝细胞肝癌（HCC）是其最主要的病理类型。外周血标志物对于HCC的诊断、病情监测和预后评估均有重要作用。目前，临床最常用的HCC外周血标志物是甲胎蛋白（AFP），但仅有50%~60%的HCC患者AFP呈阳性，这极大地限制了AFP的临床应用。近年来，随着各种检测技术的发展，越来越多的新型HCC外周血标志物被发现，如各类蛋白、循环肿瘤DNA（ctDNA）、循环游离RNA、胞外囊泡（EV）、循环肿瘤细胞（CTC），为HCC的精准诊断、预后评估和疗效评估提供了有价值的参考依据。然而，大部分新型标志物的临床意义缺乏系统性回顾，尚未用于临床实践。文章针对HCC外周血指标的临床价值进行回顾，并对其应用前景进行述评。

关键词: 循环肿瘤DNA, 循环游离RNA, 胞外囊泡, 循环肿瘤细胞, 原发性肝癌

Abstract:

Primary liver cancer is a malignant tumor with the intense incidence rate and mortality in China，and hepatocellular carcinoma（HCC） is the most important pathological type. The determination based on peripheral blood biomarkers is crucial for the diagnosis，monitoring and prognosis evaluation of HCC. The most commonly used peripheral blood biomarker in clinical practice is alpha-fetoprotein （AFP），but only about 50%-60% of HCC patients are AFP positive，greatly limiting its clinical application. In the recent years，with the development of various determination technologies，more and more new peripheral blood biomarkers for HCC have been identified，which included proteins，circulating tumor DNA（ctDNA），circulating free RNA，extracellular vesicles（EV），circulating tumor cells（CTC） and so on，providing a reference for accurate diagnosis of liver cancer，prognosis and efficacy evaluation. However，the clinical significance of the newest biomarkers lacks systematic review，which has not yet been used in clinical practice. The review focuses on the clinical value of peripheral blood determination indicators for HCC and comments on their application prospects.

Key words: Circulating tumor DNA, Circulating free RNA, Extracellular vesicle, Circulating tumor cell, Hepatocellular carcinoma

中图分类号:

R446.1

马晓路, 郭林, 卢仁泉. 原发性肝细胞肝癌患者外周血指标的临床价值及其应用前景[J]. 检验医学, 2025, 40(4): 309-316.

MA Xiaolu, GUO Lin, LU Renquan. Clinical value and application prospect of circulating biomarkers in hepatocellular carcinoma patients[J]. Laboratory Medicine, 2025, 40(4): 309-316.

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