血小板在肝细胞癌恶性进展中的作用

Role of platelets in the malignant progression of hepatocellular carcinoma

肝细胞癌(以下简称肝癌)是临床上最常见的肝脏原发性恶性肿瘤,其恶性程度高、易复发转移,患者预后极差。近年来,血小板在促进肝癌恶性进展中的作用受到广泛关注:一方面,血小板通过肿瘤微环境直接促进肝癌细胞增殖和侵袭;另一方面,血小板通过协助肿瘤细胞躲避免疫监视等途径促进肝癌细胞发生远处转移。此外,血小板特异性分泌的生长因子及促血管生成因子也直接或间接参与肝癌细胞增殖、侵袭以及肿瘤周围血管新生。另外,在大多数肝癌患者合并肝硬化的背景下,由于门静脉高压、脾功能亢进导致血小板减少是否会促进肝癌恶性进展仍无定论。基于血小板在肝癌中的作用,血小板及其相关评分在肝癌诊断和预后评估中的价值也成为研究的热点。笔者详细阐述血小板在肝癌恶性进展中的作用机制,以及血小板作为肝癌诊断和预后评估工具的最新研究进展,这对优化肝癌治疗方案和探讨新的肝癌治疗策略具有重要意义。

Hepatocellular carcinoma(HCC)is the most common primary hepatic malign-ancy in clinic.The prognosis of patients remains extremely poor because of the high malignancy and easy recurrence and metastasis of HCC.In recent years,the roles of platelets in promoting the malignant progression of HCC have increasingly attracted much attention.It is known that platelets could promote HCC cells proliferation and invasion through tumor microenvironment.On the other hand,platelets are capable to promote HCC cells distant metastasis by facilitating tumor cells evasion of immune surveillance.Besides,the platelet-derived growth factors and proangiogenic factors are also involved in the proliferation,invasiveness,and neovascularization of HCC.In addition,patients with HCC normally have a background of cirrhosis,and it is still controversial that whether the thrombocytopenia by portal hypertension and hypersplenism can promote the malignant progress of HCC.In view of this,the diagnostic and prognostic value of platelet levels,as well as platelet-associated scores in HCC have increasingly become research focus.The authors elaborate the detailed mechanisms of platelets in malignant progression of HCC,and discuss the recent research progress of platelets as effective diagnostic or prognostic tools for the assessment of HCC,which is of great importance to optimize the current treatment regimen and explore novel therapeutic strategies against HCC.