去γ-羧基凝血酶原对原发性肝细胞癌的诊断价值

目的：探讨血清肿瘤标志物去γ-羧基凝血酶原（des-γ-carboxy prothrombin,DCP）对原发性肝细胞癌（hepatocellular carcinoma,HCC）的诊断价值。方法：172例研究对象分为正常对照组（25例）、慢性肝炎组（20例）、肝硬化组（51例）及HCC组（76例）,用酶联免疫法（ELISA）测定血清DCP浓度,同时用电化学发光免疫法（ECLIA）测定血清AFP浓度,对比分析DCP、AFP及两者联合检测对HCC患者诊断的灵敏度、特异度和准确度,并对HCC病灶大小、门静脉癌栓浸润及背景肝病等临床病理特征与DCP、AFP作相关性分析。结果：正常对照组、慢性肝炎组、肝硬化组及HCC组的DCP平均浓度分别为17．72±9．59、26．12±12．64、37．45±18．26和806．71±639．79mAU／ml,可见DCP浓度在四组间呈递增趋势（P〈0．05）,且HCC组DCP浓度显著高于其它三组（P〈0．01）。正常对照组、慢性肝炎组、肝硬化组及HCC组AFP平均浓度分别为7．93±5．42、14．59±11．91、16．29±14．10和547．47±544．98ng／ml,HCC组AFP浓度也明显高于其它三组（P〈0．01）。统计分析显示血清DCP、AFP对HCC诊断阳性率分别为78．95％、73．68％,而两项联合使用对HCC诊断阳性率提高至89．47％。较大病灶（〉5cm）、门静脉癌栓（PVI）阳性HCC患者的DCP浓度高于小病灶、PVI阴性HCC患者;HBSAg阳性HCC患者DCP浓度高于HBSAg阴性HCC患者。结论：DCP对HCC具有较好的诊断价值,其浓度与HCC的病灶大小、门静脉癌栓浸润等,临床病理特征相关,且不受HBV感染的影响,适用于我国以HBV感染为背景肝病的HCC诊断,其灵敏度及特异度较AFP高,联合DCP、AFP检测能明显提高HCC的诊断率。     

去γ-羚基凝血酶原对原发性肝细胞癌的诊断价值

目的:探讨血清肿瘤标志物去γ-羧基凝血酶原(des-γ-carboxy prothrombin,DCP)对原发性肝细胞癌(hepatocellularcarcinoma,HCC)的诊断价值.方法:172例研究对象分为正常对照组(25例)、慢性肝炎组(20例)、肝硬化组(51例)及HCC组(76例),用酶联免疫法(EusA)测定血清DCP浓度,同时用电化学发光免疫法(ECLIA)测定血清AFP浓度,对比分析DCP、AFP及两者联合检测对HCC患者诊断的灵敏度、特异度和准确度,并对HCC病灶大小、门静脉癌栓浸润及背景肝病等临床病理特征与DCP、AFP作相关性分析.结果:正常对照组、慢性肝炎组、肝硬化组及HCC组的DCP平均浓度分别为17.72±9.59、26.12±12.64、37.45±18.26和806.71±639.79mAU/ml,可见DCP浓度在四组间呈递增趋势(P<0.05),且HCC组DCP浓度显著高于其它三组(P<0.01).正常对照组、慢性肝炎组、肝硬化组及HCC组AFP平均浓度分别为7.93±5.42、14.59±11.91、16.29±14.10和547.47±544.98ng/ml,HCC组AFP浓度也明显高于其它三组(P<0.01).统计分析显示血清DCP、AFP对HCC诊断阳性率分别为78.95%、73.68%,而两项联合使用对HCC诊断阳性率提高至89.47%.较大病灶(>5cm)、门静脉癌栓(PVI)阳性HCC患者的DCP浓度高于小病灶、PVI阴性HCC患者;HBSAg阳性HCC患者DCP浓度高于HBSAg阴性HCC患者.结论:DCP对HCC具有较好的诊断价值,其浓度与HCC的病灶大小、门静脉癌栓浸润等临床病理特征相关,且不受HBV感染的影响,适用于我国以HBV感染为背景肝病的HCC诊断.其灵敏度及特异度较AFP高.联合DCP、AFP检测能明显提高HCC的诊断率.     

血清AFP与AFU联合检测诊断原发性肝细胞癌

 对原发性肝细胞癌（PHC）、肝炎肝硬化及其它各种恶性肿瘤患者共419例进行血清a－L－岩藻糖苷酶（AFU）和甲胎蛋白（AFP）的测定，并以60名健康人作对照，结果PHC组的AFU活性（241．9±112．5）显著高于健康对照组（116．1±28．0）及其他各组（P<0．01），AFU活性对PHC诊断的敏感性为69．6％，特异性为90．1％，AFU活性与AFP浓度间无明显相关性，AFP与AFU联合检测对PHC的诊断率可提高到89．6％，且随病情好转和恶化而下降和上升，提示检测血清AFU活性对PHC的诊断、疗效观察均有重要的临床价值。     

术前CT征象联合甲胎蛋白预测孤立性肝细胞癌早期复发的价值

目的 探讨术前CT征象联合甲胎蛋白(α?fetoprotein,AFP)在孤立性肝细胞癌(hepatocellular carcinoma,HCC)患者术后早期复发中的预测价值.方法 选择2015年6月—2017年5月在广西医科大学附属肿瘤医院收治的孤立性HCC患者为研究对象,收集其临床数据以及CT征象,采用logis...     

血清AFP-L3、GP73检测联合CT扫描在肝细胞癌诊断中的价值

目的:检测肝病患者血清中甲胎蛋白异质体(AFP-L3)和高尔基体蛋白73(GP73)浓度,分析肝病患者病灶CT平扫加增强扫描后经处理技术得到二维及三维重建图像,探讨联合运用AFP-L3、GP73浓度检测与CT扫描两种技术在肝细胞癌(hepatocellular carcinoma,HCC)诊断中的价值。方法:采用酶联免疫吸附法检测肝病患者血清AFP-L3、GP73浓度,运用受试者工作特征曲线(recover operation characteristic,ROC)确定AFP-L3、GP73浓度诊断HCC的cut-off值。分析141例肝病患者总共164个病灶的CT扫描后经处理技术得到二维及三维重建图像而诊断HCC,探讨采用AFP-L3、GP73浓度测定与CT增强扫描及这两种方法联合应用在HCC的检出与定性诊断方面的价值。结果:HCC组AFP-L3浓度(113.58±63.62)ng/ml明显高于良性肝病组[(23.19±34.54)ng/ml,P<0.001],绘制AFP-L3浓度诊断HCC的ROC曲线,AFP-L3浓度38.47ng/ml为诊断HCC的cut-off值,诊断敏感性为81.08%,特异性为88.06%,诊断正确率为87.23%;HCC组GP73浓度(126.55±49.56)ng/ml明显高于良性肝病组[(56.97±26.48)ng/ml,P<0.001],绘制GP73浓度诊断HCC的ROC曲线,GP73浓度69.44ng/ml为诊断HCC的cut-off值,诊断敏感性为75.68%,特异性为91.04%,诊断正确率为88.65%。CT扫描诊断HCC的灵敏度为82.43%,特异度为91.04%,诊断正确率为90.07%。联合AFP-L3、GP73浓度检测与CT扫描诊断HCC的灵敏度为85.14%,特异度为92.53%,诊断正确率为92.19%。结论:联合运用血清AFP-L3、GP73浓度检测及CT扫描两种技术对HCC诊断灵敏度、特异度、诊断正确率较运用单一技术均有所提高,联合运用两种技术对HCC的准确早期诊断具有积极的意义。     

术前MR影像特征对肝细胞癌手术切除术后早期复发的预测价值

目的:探究肝细胞癌(hepatocellular carcinoma,HCC)术前临床资料及MR影像特征对HCC手术切除术后早期复发(2年内复发)的预测价值。方法:回顾性分析2015年1月至2018年1月间在天津医科大学肿瘤医院行手术切除术的244例HCC患者资料。对可能影响HCC手术切除术后早期复发的术前临床资料及MR影像特征行单因素、多因素分析。所有患者出院后均规律随访,终点事件为术后2年内肝内复发。结果:单因素分析筛选出肿瘤最大径、肿瘤包膜、瘤周肝实质强化、环形强化、TTPVI、瘤内坏死、卫星灶、动态增强模式、DWI/T2WI不匹配等MR影像特征及甲胎蛋白(alpha-fetoprotein,AFP)、TNM分期、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、谷氨酸氨基转移酶(glutamatergic aminotransferase,AST)、直接胆红素(direct bilirubin,DBIL)、γ-谷氨酰转肽酶(γ-glutamyl transferase,γ-GT)等临床资料为肝癌患者切除术后早期复发的影响因素。将上述变量纳入多因素Co...     

血清标志GlyPican-3对肝细胞癌诊断价值初步评价

目的：探讨人血清磷脂酸肌醇蛋白聚糖-3（GlyPican-3）和甲胎蛋白（a—fetoprotein,AFP）联合检测对肝细胞癌（hepatocellularcarcinoma,HCC）诊断的临床价值。方法：收集2011—1l—02-2013—01—13遵义市第一人民医院174例和青岛市城阳区人民医院44例,门诊和肝胆外科人外周血血清218例,其中HCC54例,肝硬化36例,肝炎40例,肝良性肿瘤18例,其他恶性肿瘤40例,健康志愿者30名。双抗体夹心酶联免疫定量测定方法和电化学发光法检测血清中GlyPican-3和AFP的表达水平,结果以中位数（M）表示。制作受试者工作特征（receiveroperatingcharacteristic,ROC）曲线,以曲线下面积（areaundercurve,AUC）反映诊断的准确性。结果：HCC组血清GlyPican-3的表达水平为654．67ρg／mL,显著高于肝硬化组的32．83ρg／mL、肝炎组的33．04ρg／mL、肝良性肿瘤组的15．14ρg／mL、其他恶性肿瘤组的25．82ρg／mL和健康志愿者组的3．90ρg／mL,P值均〈0．001;GlyPican-3组AUC为0．883,95％CI：0．833～0．923;AFP组为0．802,95％CI：0．743～0．853;GlyPican-3和AFP联合检测为0．945,95％CI：0．905～O．971。GlyPican-3和AFP联合检测显著高于单个检测指标,Z值分别为5．944和3．409,P值分别为〈0．001和0．007。GlyPican-3取最佳临界值为60ρg／mL时,GlyPican-3诊断HCC的灵敏度和特异度分别为85．18％（46／54）和73．78％（121／164）;GlyPican-3联合AFP检测诊断HCC的灵敏度可达96．29％（52／54）。血清GlyPican-3的表达水平随HCC的临床分期增加而升高,H=4．571,P=0．025。结论：血清GlyPican-3的表达水平对于HCC具有较高的诊断价值,血清GlyPican-3联合AFP检测可提高HCC的诊断率。血清GlyPican-3的表达水平与,临床分期有关。     

腹部B超联合甲胎蛋白对肝细胞癌的诊断效果

目的 比较B超或甲胎蛋白(alpha fetal protein,AFP)对肝细胞癌的诊断效果,探讨最佳的诊断方式.方法 按性别和年龄采用1:1配对研究方式选取病例组和对照组样本,在掌握其B超下肝脏占位性病变的直径和AFP结果的基础上,利用受试者工作曲线得到直径和AFP的最佳分界值,进而比较B超和AFP单用或联用时诊断HCC的效果.结果 病例组患者B超下肝脏占位性病变的直径和血清AFP值都要明显高于对照组患者[(3.53±1.88)cm vs.(2.10±2.12)cm,T=4.441,P<0.01;(211.61±322.77)ng/ml vs.(110.08±211.81)ng/ml,T=2.324,P=0.023].利用B超诊断时曲线下面积为0.69,虽然大于AFP诊断时的曲线下面积0.61,但2个面积值无明显的统计学差异(Z=1.30,P=0.09).利用B超下肝脏占位性病变的直径值诊断HCC具有较高的灵敏度和阴性预测值,但B超联合AFP的诊断特异度最高,达到了96.3%.利用AFP诊断和B超诊断具有明显的差异性(χ2=156.755,P<0.01),并且2种诊断方法的一致性较差(Kappa=0.157,P=0.023).结论 B超和AFP在HCC的诊断上具有明显差异,并且一致性较差,单独使用B超诊断时的灵敏度较单独使用AFP诊断时要高,但两者联合诊断时的特异度要明显优于其单独使用时的诊断模式.     

Platelet-to-Lymphocyte Ratio and Large Tumor Size Predict Microvascular Invasion after Resection for Hepatocellular Carcinoma

Background: Recurrence after curative resection of hepatocellular carcinoma (HCC) is associated with early deathand poor prognosis. Microvascular invasion (mVI) is strongly associated with disease recurrence. Although many studieshave examined the relationship between various serum inflammatory indices and post-treatment prognosis, little isknown about preoperative predictors of microvascular invasion in HCC. Methods: Patients who underwent curativehepatic resection for HCC at our institute from January 2006 to December 2016 were retrospectively reviewed. Theassociations between mVI and various potential risk factors, including tumor size, hepatitis B and C virus infection,Child–Pugh scores, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio, were analyzed. Optimal cut-offvalues were determined using receiver operating characteristic curves. Results: A total of 330 HCC patients wereenrolled in this study, of whom 74 (22.4%) had tumors with mVI. After univariate analysis, two parameters weresignificantly associated with mVI after hepatic resection: platelet-to-lymphocyte ratio ≥102 (odds ratio [OR] 2.385,p = 0.001) and tumor size ≥5 cm (OR 4.29, p < 0.001). Both variables remained significant risk factors for mVI aftermultivariate analysis: platelet-to-lymphocyte ratio ≥102 (OR 1.831, p = 0.034) and tumor size ≥5 cm (OR 3.791,p < 0.001). Conclusions: Large tumor size (≥5 cm) and high platelet-to-lymphocyte ratio (≥102) are independentpredictive factors for mVI in HCC.     

血清4项肿瘤标志物联合检测在原发性肝癌诊断中的应用价值

目的探讨甲胎蛋白异质体3(AFP-L3)、高尔基体蛋白73(GP73)和磷脂酰肌醇蛋白聚糖-3(GPC-3)及甲胎蛋白(AFP)联合检测在原发性肝癌诊断中的应用价值。方法采用酶联免疫吸附试验(EL1SA)检测100例原发性肝癌(HCC)、100例肝炎肝硬化患者血清AFP-L3、GP73、GPC-3,同时用电化学发光法检测血清甲胎蛋白(AFP),同期选择100例门诊正常体检者作为对照组。对各指标表达情况进行比较和分析。结果原发性肝癌血清AFP、AFP-L3、GP73、GPC-3含量均显著高于肝炎肝硬化组及健康对照组,差异均有统计学意义(P<0.05);AFP、AFP-L3、GP73、GPC-3联合检测的阳性率达86.0%,明显高于单项检测AFP(54.0%)、AFP-L3(55.0%)、GP73(48.0%)和GPC-3(43.0%)(P<0.05);且AFP、AFP-L3、GP73、GPC-3联合检测的敏感性均高于单一检测指标,差异有统计学意义(P<0.05),但其特异性显著低于AFP-L3、GP73单项检测(P<0.05)。结论联合检测血清AFP、AFP-L3、GP73、GPC-3含量可以提高对原发性肝癌的阳性诊断率,对早期诊断具有重要的临床意义。     

C反应蛋白与白蛋白比值对原发性肝癌患者预后的判断价值

目的 探讨C反应蛋白（CRP）与白蛋白（Alb）比值对原发性肝癌患者预后的判断价值。方法 纳入首次行手术治疗的原发性肝癌患者178例,计算术前CRP/Alb,运用受试者工作特征曲线、生存分析和Cox多元回归分析评价CRP/Alb与预后的关系。结果 CRP/Alb比值的最佳界点为0.46,敏感度为70.45%,特异度为73.97%。与低CRP/Alb组相比,高CRP/Alb组的CRP水平较高、Alb水平较低、Child-Pugh分级较高、肿瘤最长径较大、血管浸润比例较多,差异均有统计学意义（P<0.001）。Kaplan-Meier曲线显示高CRP/Alb组的生存率较低（26.8% vs. 56.8%, P<0.001）。Cox多元回归分析显示CRP/Alb、Child-Pugh分级、血管浸润是预后的独立危险因素。结论 术前CRP/Alb比值升高提示原发性肝癌患者预后不良,是影响患者预后的独立危险因素。     

血小板及其参数联合肿瘤标志物术前鉴别肝细胞癌及肝内胆管癌的临床价值

目的 探讨血小板(PLT)及其参数和甲胎蛋白(AFP)、糖类抗原199(CA199)、糖类抗原125(CA125)及癌胚抗原(CEA)在术前肝细胞癌(HCC)及肝内胆管癌(ICC)鉴别诊断中的价值.方法 回顾性分析兰州大学第二医院行手术治疗的肝癌患者274例,据术后病理将其分为HCC组229例和ICC组45例.比较两组...     

Predictive Value of Serum Insulin-like Growth Factor-1 in Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver inthe world. Insulin-like growth factor-1 (IGF-1) levels reflect hepatic function and are inversely correlated withthe severity of background chronic liver disease. Objective: This study evaluated whether basal serum IGF-1levels can predict prognosis of HCC patients according to different risks of disease progression. Materials andMethods: A total of 89 patients with hepatocellular carcinoma (HCC) were recruited in 3 groups: Group I, 30HCC patients receiving sorafinib; Group II, 30 HCC patients with best supportive care; and Group III include29 patients undergoing transcatheter arterial chemoembolization (TACE). All patients were investigated forserum levels of AST, ALP, Bb, Cr, BUN, AFP and IGF-I. Results: Patients with disease control had significantlyhigher baseline IGF-1 levels 210 (185-232.5) ng/mL (p value<0.01) than did patients without disease control.Low basal IGF-1 levels were associated with advanced HCC, such as multiple tumors and advanced stage, andlow IGF-1 levels predicted shorter TTP and overall survival in patients treated with TACE. Conclusions: Thelevels of serum IGF-1, expressed as continuous values, may be helpful for accurately assessing hepatic functionand the prognostic stratification of patients with HCC.     

Early Skin Toxicity as a Predictive Factor for Tumor Control in Hepatocellular Carcinoma Patients Treated with Sorafenib

Introduction.

Sorafenib is an oral multikinase inhibitor that targets Raf kinase and receptor tyrosine kinases and has led to a longer median overall survival (OS) time and time to progression (TTP) in patients with advanced hepatocellular carcinoma (HCC). This study was conducted to assess the link between the antitumor efficacy of sorafenib and its early cutaneous side effects in advanced HCC patients.

Materials and Methods.

All patients received 800 mg daily of sorafenib until progression or unacceptable toxicities. We retrospectively analyzed the incidence of rash and hand–foot skin reactions (HFSR) during the first month of treatment, comparing tumor control (partial response plus stable disease) and TTP.

Results.

Sixty-five HCC patients treated with sorafenib were included in this analysis: 47 (73.3%) received sorafenib after failure of some local treatment, whereas 18 (27.7%) received it as first-line treatment. Twenty-nine patients developed at least grade 1 skin toxicity (rash, 13; HFSR, 16). In patients who developed skin toxicity, the tumor control rate was 48.3%, versus 19.4% in patients without cutaneous side effects. The median TTP was 8.1 months in the group of patients with skin toxicity versus 4.0 months in those without skin toxicity. This difference was also statistically significant on multivariate analysis. A borderline statistically significant difference was also observed in terms of OS in patients with early skin toxicity.

Conclusions.

Skin toxicity should be closely monitored in HCC patients treated with sorafenib in relation to its potential role as a surrogate marker of efficacy.     

Diagnostic and Prognostic Value of Talin-1 and Midkine as Tumor Markers in Hepatocellular Carcinoma in Egyptian Patients

Background: Hepatocellular carcinoma (HCC) is a main cause of cancer death all over the world. Treatment andoutcome of HCC based on its early diagnosis. This study was conducted to estimate the role of talin-1 and midkine incombination with total antioxidant capacity (TAC) as tumor markers in HCC patients. Methods: Serum levels of talin-1and midkine were measured in 90 Egyptian subjects including 44 patients with HCC, 31patients with cirrhosis and 15healthy controls using enzyme-linked immunosorbent assay (ELISA) technique. While a colorimetric method was usedfor measurement of TAC. Results: Serum talin-1 in HCC patients was significantly lower than that in patients withcirrhosis (P<0.001) and normal control (P<0.001). In addition, increased invasion and metastasis correlated with reducedtalin-1 level. Serum midkine in HCC patients was significantly higher compared to cirrhotic patients (P<0.001) andnormal control (P<0.001). Midkine at a cut off value of 1683 pg/ml showed a sensitivity of (81.82%) and specificity of(83.87%). While alpha-fetoprotein (AFP) at a cut off value of 200 ng/ml had a sensitivity of (52.27%), while specificitywas (96.77%). Midkine was positive in 80.9% of HCC patients with negative AFP. Serum TAC was significantlydecreased in HCC patients when compared with control group (P<0.001). Conclusion: Talin-1 may be implicatedin the carcinogenesis and metastasis of HCC and can be used as a useful tumor marker for HCC. Midkine may be apotential diagnostic marker for HCC and may be used in addition to AFP to increase the sensitivity of HCC detection.     

大剂量分割三维适形放疗对原发性肝癌门静脉癌栓的疗效

目的观察大剂量分割三维适形放疗（3-dimensional conformal radiotherapy,3DCRT）对不能手术切除的原发性肝癌（hepatocellular carcinoma,HCC）门静脉癌栓（portal vein tumor thrombus,PVTT）的疗效。方法对56例不能手术切除的HCC伴PVTT患者,根据肿瘤体积大小行大剂量分割3DCRT,放疗剂量为4～8Gy,每周3次,48～58Gy,3.0～3.5周完成。大体肿瘤靶区（GTV）包括癌栓及靠近的原发灶,90%等剂量曲线覆盖计划靶区（PTV）。结果有效率（CR＋PR）为58.9%（33/56）,1、2年生存率分别为47.4%和17.5%。患者耐受性好,无严重放疗并发症。结论大剂量分割3DCRT对HCC合并PVTT有较好的疗效。     

肿瘤坏死因子联合VP16对小鼠肝细胞癌的疗效观察

以小鼠移植性肝细胞癌为模型，探讨重组人肿瘤坏死因子（ｒｈＴＮＦ）和足叶乙甙（ＶＰ_（１６））的协同抗肿瘤作用。结果显示ｒｈＴＮＦ或ＶＰ_（１６）均能使肿瘤生长受到一定的抑制，肿瘤出现一定程度的坏死，ｒｈＴＮＦ并能抑制腹水的形成，但均不能显著延长荷瘤小鼠的生存时间，而联合应用则显著抑制肿瘤生长，肿瘤出现广泛的出血坏死，无明显腹水形成，荷瘤小鼠生存时间显著延长，且对机体的毒性增加不明显，说明两者具有协同抗肿瘤作用，具有进一步临床应用探讨价值，尤其是对化疗不敏感的肿瘤。