精氨酸酶-1在原发性肝癌及肝转移癌鉴别中的作用

目的： 探讨精氨酸酶-1(Arg-1)在原发性肝癌(PHC)和肝转移癌(HM)鉴别中的意义。方法：123例肝癌患者行超声引导下细针穿刺活检，标本制作成细胞块进行免疫组化染色，观察Arg-1表达情况。所有患者行手术切除后进行组织病理学诊断，结合细胞学、血清肿瘤标记物、临床及影像学随访结果进行最终判定。计算采用Arg-1鉴别PHC和HM的敏感度和特异性。结果：123例患者中PHC 78例，HM 45例。在PHC患者中，Arg-1呈高表达(83.3%)且以强染色为主(60.3%)，高、中度分化肝细胞癌患者中阳性表达率(92.9%)高于低分化患者(76.9%)，在胆管细胞型肝癌患者中不表达，在混合型肝癌患者中阳性表达率为75%；在HM患者中，Arg-1阳性表达率较低(8.9%)，存在于结直肠癌、胰腺癌、乳腺癌肝转移患者中且均为弱染色，其他原发部位肝转移患者未见Arg-1阳性表达。Arg-1用于PHC和HM鉴别的敏感度为83.3%，特异性为91.1%。结论：细针穿刺活检标本行Arg-1免疫组化染色用于PHC和HM鉴别的敏感度和特异性均较高，值得进一步推广。

Effects of arginase-1 in identifying primary hepatocellular carcinoma and hepatic metastasis

OBJECTIVE： To study the significance of arginase-1 （Arg-1） in identifying primary hepatic carcinoma （PHC） and hepatic metastasis （HM）. METHODS：Fine-needle aspiration biopsies （FNABs） were performed in 123 patients,cell block were made and immunohistochemical staining were applied. The expression of arginase-1 was measured. All patients received surgical resection and histopathologic diagnosis were obtained. Cytology,serum tumor markers,clinical and radiographic follow-up results were used for a final decision. The sensitivity and specificity of Arg-1 in identifying PHC and HM were calculated. RESULTS：123 patients diagnosed to have PHC （78 cases） or HM （45 cases）. High expression was present in PHC group （83.3%） and stained strongly （60.3%）. Positive expression rate of highly and moderately differentiated patients （92.9%） were higher than lowly differentiated patients （76.9%）,with no expression in cholangiocarcinoma patients. In the hybrid liver cancer patients the positive expression rate was 75%. In patients with HM,Arg-1 positive expression rate was low （8.9%） with weak staining,and were found in HM from colorectal cancer,pancreatic cancer. HM from other primary sites showed no Arg-1 positive expression. The sensitivity and specificity of Arg-1 in identifying PHC and HM were 83.3% and 91.1%,respectively. CONCLUSION：Arginase-1 may be a more sensitive marker of hepatocellular carcinoma （HCC） and hepatic metastasis. FNABs with Arg-1 immunohistochemical staining was sensitive and specific in identifying PHC and HM and warrant further promotion.