纤维蛋白原/前白蛋白比值、γ-谷氨酰转肽酶/血小板比值在甲胎蛋白阴性肝细胞癌中的应用价值

目的 评估纤维蛋白原/前白蛋白比值(FPR)、γ-谷氨酰转肽酶/血小板比值(GPR)在甲胎蛋白阴性肝细胞癌(AFP-N HCC)患者中的应用价值.方法 2018年3月至2020年3月AFP-N HCC患者(AFP-N HCC组)80例(男58例、女22例),年龄(50.2±9.8)岁.另选取同期健康体检患者(健康组)1...     

寡糖链检测对HBV相关性肝细胞癌的诊断价值

目的 探讨寡糖链检测在乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)诊断中的临床价值.方法 收集2017年2月至2018年8月就诊于南京医科大学第一附属医院并符合纳入与排除标准的435名受试者的血清及相关资料,共分为五组,其中健康对照组(HC)80例、慢性乙型肝炎(CHB)组105例、乙型肝炎肝硬化(LC)组60例、其...     

GALAD模型在诊断HBV相关肝细胞癌中的价值探讨

目的探讨GALAD模型在HBV相关肝细胞癌中的诊断价值。方法回顾性分析204例HBV感染住院患者,根据诊断分为HCC组及对照组,比较AFP、AFP-L3%、异常凝血酶原(DCP)、三项联合及GALAD模型诊断HCC的受试者工作曲线(ROC)下面积(AUC)、敏感性、特异性差异。结果HCC组中AFP、AFP-L3%、DCP及GALAD模型Z值水平均高于对照组,AFP、AFP-L3%、DCP单项、三者联合及GALAD模型诊断的AUC分别为0.760、0.742、0.865、0.887,0.937,GALAD模型AUC与三项标志物及其联合的AUC两两比较,差异均有统计学意义(P<0.05)。GALAD模型诊断的敏感性为83.82%,高于AFP、AFP-L3、DCP单项,与三项并联相当,特异性为86.03%。结论GALAD模型在HBV相关HCC诊断中显示了良好的效能,优于AFP、AFP-L3%、DCP及三项联合诊断,具有一定临床参考价值。     

HBsAg及AFP在肝细胞癌组织中的表达及其相关性

目的进一步探讨HBV感染在肝细胞癌（HCC）发病中的作用。方法选择40份HCC、癌旁肝组织标本及6份正常肝组织标本,用免疫组化SP法检测其HBsAg与甲胎蛋白（AFP）表达。结果正常肝组织中HBsAg及AFP表达均为阴性;HCC和癌旁肝组织中HBsAg及AFP表达阳性率分别为70%、90%（P〈0.05）,HCC和癌旁肝组织AFP表达阳性率分别为87.5%、82.5%（P〉0.05）;HCC及癌旁肝组织中HBsAg阳性者AFP表达阳性率明显高于HBsAg阴性者（P〈0.05）。结论 HBV感染可能通过诱发肝细胞产生AFP参与HCC发病,具体机制有待进一步研究。     

肝移植与肝细胞癌：肝细胞癌病人的肝移植

背景：肝移植（LT）已被提倡作为对不可切除的肝细胞癌（HCC）的补救疗法。选择标准在台湾仍需要完善。     

iNOS在肝细胞癌组织中的表达及其临床意义

肝细胞癌(HCC)是我国常见恶性肿瘤之一,其死亡率占消化系统恶性肿瘤第3位.它的发生、发展是多种癌相关基因协同作用的结果.一氧化氮(NO)是体内重要的生物活性分子和信号分子,它作为血管扩张因子、神经递质、抗微生物效应分子和免疫调节剂具有多种生理和病理功能.诱导型一氧化氮合酶(iNOS)主要在病理情况下,如炎症和肿瘤诱导下生成NO,参与血管生成、肿瘤的发生和发展等过程[1].本研究通过检测HCC癌组织中的iNOS的表达情况及其与临床生物学特点之间的关系,探讨iNOS与HCC的关系.     

肝细胞癌分期系统的临床意义与进展

大多数实体瘤患者肿瘤的诊断和分期与其生存期有关,且直接影响治疗指征。肝细胞癌患者生存期的预测较复杂,目前国际上对肝细胞癌分期系统尚无统一的认识。若分期系统只考虑预后参数,如肿瘤、淋巴结、转移或Child—Pugh分级中的一种,那该分期系统是无用的。已建立的几个分期系统,均对终末期患者有确定能力而与治疗无关联。巴塞罗纳临床肝细胞癌分期系统是在几个队列和临床随机研究结果基础之上建立的,集肿瘤状态、治疗方案与预测生存期为一体的分期系统。     

血清寡糖链检测对HBV相关肝细胞癌的诊断价值

目的评价寡糖链检测(G-Test)试剂盒(荧光毛细管电泳法)辅助诊断HBV相关肝细胞癌(HCC)的临床价值。方法收集2017年8月-2018年6月就诊于北京佑安医院的患者血清样本310例,其中HBV相关HCC(HCC组)170例,乙型肝炎肝硬化(肝硬化组)50例,慢性乙型肝炎(肝炎组)85例,其他脏器恶性肿瘤(其他恶性肿瘤组)5例。检测血清寡糖链组分的相对浓度,计算并分析G-Test试剂盒在临床诊断中的灵敏度、特异度、总符合率和阳性预测值、阴性预测值,并与血清AFP进行方法学比较。非正态计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较使用Dunn’s多重比较,计数资料两组间比较采用χ2检验。利用受试者工作特征曲线(ROC曲线)对诊断效能进行分析,利用logistic回归建立G-Test与AFP联合诊断模型,受试者工作特征曲线下面积(AUC)的比较采用Z检验。结果HCC组患者G值[6.46(5.73~7.07)]明显高于肝炎组[3.38(2.85~4.18)]及肝硬化组[3.99(3.13~5.21)]患者(H值分别为107.9、104.2,P值均<0.001)。HCC组患者AFP的水平明显高于肝炎组患者[0.77(0.45~1.77)log10 ng/ml vs 0.58(0.41~0.89)log10 ng/ml,H=33.65,P=0.025]。G-Test的灵敏度83.53%,特异度为74.29%,总体符合率为79.36%,阳性预测值79.78%,阴性预测值78.79%。G-Test与AFP单独诊断的AUC分别为0.846与0.611,G-Test的AUC明显高于AFP(Z=5.795,P<0.001),G-Test联合AFP诊断的AUC为0.870,明显优于G-Test(Z=2.523,P=0.012)与AFP(Z=6.943,P<0.001)单独诊断效能。HCC早期与中晚期组间G-Test检出率均高于AFP>400 ng/ml检出率(χ2值分别为26.441、38.379,P值均<0.001)。AFP分别以<20、<200、<400 ng/ml为阴性临界值,G-Test在AFP阴性的HCC患者中检出率分别为86.24%、85.93%、85.31%。结论G-Test的灵敏度和特异度较好,具有辅助诊断HCC的临床应用价值,联合AFP诊断效能更好。     

甲胎蛋白应答在肝细胞癌治疗中的预后价值

肝细胞癌（HCC）是最常见的肝脏恶性肿瘤。因其恶性程度高、预后差,准确评估患者的治疗效果及预后情况至关重要。尽管目前影像学是肝癌预后评估的标准方法,但其仍存在诸多局限性。甲胎蛋白是重要的肝癌肿瘤标志物,广泛的应用于肝癌的筛查、诊断及预后评价。总结了甲胎蛋白应答在评判肝癌患者预后的相关文献。整体上,甲胎蛋白应答在肝癌患者接受射频消融、肝动脉化疗栓塞、钇90放射性栓塞、索拉菲尼等分子靶向药物、全身化疗、肝动脉灌注化疗或同步放化疗等治疗后具有良好的预后价值。     

Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population

BACKGROUND Despite being the world's most widely used system for staging and therapeutic guidance in hepatocellular carcinoma(HCC) treatment, the Barcelona clinic liver cancer(BCLC) system has limitations, especially regarding intermediate-grade(BCLC-B) tumors. The recently proposed Hong Kong liver cancer(HKLC) staging system appears useful but requires validation in Western populations.AIM To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population, estimating the overall patient survival.METHODS This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and 2016. Demographic, clinical, and laboratory data were collected. HCC staging was carried out according to the HKLC and BCLC systems to assess treatment agreement. Overall survival was estimated based on the treatment proposed in each system.RESULTS A total of 519 HCC patients were assessed. Of these, 178(34.3%) were HKLC-I; 95(18.3%) HKLC-IIA; 47(9.1%) HKLC-IIB; 29(5.6%) HKLC-IIIA; 30(5.8%) HKLCIIIB; 75(14.4%) HKLC-IV; and 65(12.5%) HKLC-V. According to the BCLC, 25(4.9%) were BCLC-0; 246(47.4%) BCLC-A; 107(20.6%) BCLC-B; 76(14.6%) BCLCC; and 65(12.5%) BCLC-D. The general agreement between the two systems was80.0%-BCLC-0 and HKLC-I(100%); BCLC-A and HKLC-I/HKLC-II(96.7%);BCLC-B and HKLC-III(46.7%); BCLC-C and HKLC-IV(98.7%); BCLC-D and HKLC-V(41.5%). When sub-classifying BCLC-A, HKLC-IIB, HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion, 13.4, 66.0, 100 and36.7%, respectively, of the cases were classified as up-to-7 out.CONCLUSION In a Western population, the general agreement between the two systems was80.0%, although in BCLC-B cases the agreement was low, suggesting that some individuals could be candidates for the curative treatment recommended by the HKLC. The authors suggest that the BCLC system should be routinely employed,although for BCLC-B cases it should be associated with the HKLC system.     

肝癌患者血清P53抗体检测的临床意义

目的 探讨血清p53抗体检测对肝癌的诊断价值.方法 应用酶联免疫法(ELISA)检测46例肝癌患者血清p53抗体,对照组为30例健康体检者.结果 (1)46例肝癌患者中18例血清p53抗体阳性,阳性率为39.1%,对照组均阴性,有显著性差异(P＜0.01),(2)肝癌患者血清p53抗体阳性率与AFP水平,病理分化程度及肿瘤大小无相关关系(P＞0.05).结论 血清p53抗体检测可以作为肝癌辅助诊断的指标.     

Impact of MAFLD on the complications after hepatectomy in patients with HBV-related hepatocellular carcinoma

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a term that was proposed in 2020 by a group of international experts. However, the impact of MAFLD on complications after hepatectomy in patients with hepatocellular carcinoma is not clear. The aim of this study is to explore the influence of MAFLD on the complications after hepatectomy in patients with hepatitis B virus-related hepatocellular carcinoma (HBV-HCC). Patients with HBV-HCC who underwent hepatectomy between January 2019 and December 2021 were consecutively enrolled. The predictors of complications after hepatectomy in HBV-HCC patients were retrospectively analyzed. Among the 514 eligible HBV-HCC patients, 117 (22.8%) were diagnosed with concurrent MAFLD. Post hepatectomy complications occurred in 101 patients (19.6%), including 75 patients (14.6%) with infectious complications and 40 patients (7.8%) with major complications. Univariate analysis showed that MAFLD was not the risk factor for complications after hepatectomy in patients with HBV-HCC (P > .05). However, univariate and multivariate analysis revealed that lean-MAFLD was an independent risk factor for post hepatectomy complications in patients with HBV-HCC (odds ratio 2.245; 95% confidence interval 1.243–5.362, P = .028). Similar results were found in the analysis of predictors for infectious and major complications after hepatectomy in patients with HBV-HCC. MAFLD commonly coexists with HBV-HCC and is not directly associated with complications after hepatectomy, but lean-MAFLD is an independent risk factor for post hepatectomy complications in patients with HBV-HCC.     

Alpha-fetoprotein in patients with hepatocellular carcinoma after transcatheter arterial embolization

To assess the usefulness of alpha-fetoprotein (AFP) in monitoring treatment effects of transcatheter arterial embolization (TAE) in hepatocellular carcinoma (HCC) patients, a total of 31 sets of AFP levels after TAE in 21 HCC patients were analysed by linear regression between logarithmic AFP levels and days. Eleven sets of AFP data with poor linear declination were accompanied with poor TAE results except in one patient who had chronic hepatitis with acute exacerbations. Twenty sets of data with good linear declination in the first month after TAE indicated good TAE results. Seven of them showed no evidence of tumour recurrence nor elevated AFP levels within a follow-up of 6 months. The mean, standard deviation and range of half-lives of AFP in the non-recurrent group were 5.0, 1.6 and 2.9-7.2 days, respectively. The others experienced late tumour recurrence that was detected by rebound of AFP levels except one who had another non-AFP-secreting HCC. Thus, the results might be used as a reference in monitoring the treatment effects of TAE and the timing selection of repeated TAE.     

Highly enhanced fucosylation of serum glycoproteins in patients with hepatocellular carcinoma

BACKGROUND: We recently reported that the measurement of Lens culinaris agglutinin-reactive species of alpha-fetoprotein (AFP), alpha-1-antitrypsin (AAT) and transferrin (TF) is useful for the diagnosis of hepatocellular carcinoma (HCC) and that the molecular basis for this reactivity is fucosylation at the innermost N-acetylglucosamine residue of a biantennary sugar chain. However, the precise relationship of the fucosylation of AFP, AAT and TF in patients with HCC and liver cirrhosis is not fully understood. The aim of this study is to delineate the relationship of the fucosylation between these three glycoproteins in HCC. METHODS: Three hundred and thirty-four patients with HCC were referred to our university hospital from 1987 to 1997. An increase in serum AFP (> 20 ng/mL) was observed in 233 (69.8%) patients with HCC. From these 233 patients with AFP-producing HCC, 60 serum samples were randomly selected and used in the present study. As a reference, samples from 60 patients with liver cirrhosis, in which 30 had increased AFP, were used. Lens culinaris agglutinin (LCA)-reactive species were determined by crossed immunoaffinoelectrophoresis (CIAE). The contents of the fucosylated biantennary chain of purified AAT and TF samples were determined as pyridylamino derivatives of each oligosaccharide with high-performance liquid chromatography (HPLC). RESULTS: There was a highly significant correlation between LCA-reactive species by CIAE and pyridyl-amino-fucosylated biantennary sugar chain by HPLC in both AAT and TF. Lens culinaris agglutinin-reactive species of AFP, AAT and TF in HCC were significantly higher than those in liver cirrhosis. A highly statistically significant positive correlation of fucosylated glycans was observed between AAT and TF in both HCC and liver cirrhosis, but not between AFP and AAT or between AFP and TF. Accordingly, the present results indicate that highly enhanced fucosylation of serum glycoproteins was found in HCC compared with liver cirrhosis and that the combination of measurements of fucosylated AFP with AAT or TF were useful for the diagnosis of HCC.     

Staging systems of hepatocellular carcinoma:A review of literature

Hepatocellular carcinoma(HCC)is a major health problem with a high incidence and mortality all over the world.Natural history of HCC is severe and extremely variable,and prognostic factors influencing outcomes are incompletely defined.Over time,many staging and scoring systems have been proposed for the classification and prognosis of patients with HCC.Currently,the non-ideal predictive performance of existing prognostic systems is secondary to their inherent limitations,as well as to a non-universal reproducibility and transportability of the results in different populations.New serological and histological markers are still under evaluation with promising results,but they require further evaluation and external validation.The aim of this review is to highlight the main tools for assessing the prognosis of HCC and the main concerns,pitfalls and warnings regarding its staging systems currently in use.