血清肿瘤标志物在原发性肝癌诊断中的研究进展

原发性肝癌是目前全球第五常见恶性肿瘤及第三位肿瘤致死性病因。原发性肝癌早期诊断困难，缺乏特异和敏感的血清肿瘤标志物。甲胎蛋白和CA19-9分别是目前临床应用最广泛的肝细胞肝癌和肝内胆管细胞癌诊断标志物，但其特异性和敏感性不高。因此迫切需要新型有效的肿瘤标志物。本文就目前原发性肿瘤标志物研究进展作一简要概述。     

肝细胞癌肿瘤标志物的新进展

肝细胞癌(HCC)是最常见的恶性肿瘤之一,在中国其病死率居恶性肿瘤的第三位.肿瘤标志物的测定是早期诊断和监测复发的有效方法 ,近年来这方面的研究进展迅速,它可包括癌胚抗原和糖类抗原、酶和同工酶、基因和细胞因子等四大类.本文综述了它们在HCC诊断、疗效评价、预后判断以及复发监测等方面的研究进展,并介绍了一些近年新发现的一些肿瘤标志物,如白介素6、LAM4基因、NDRG1基因等.     

肝癌与肝炎标志物及相关肿瘤标志物的相关性分析

目的探讨乙肝五项、HCV抗体、血清甲胎蛋白(AFP)、CA19-9、CA125、CEA对原发性肝癌的诊断价值。方法对75例原发性肝癌患者分别测定乙肝五项、HCV抗体、肝脏肿瘤血清标志物AFP、CA199、CA125、CEA。结果 5例原发性肝癌患者中,HBsAg阳性45例(60.0%),HCV抗体阳性16例(21.3%),HBsAg并HCV抗体双阳性3例(4.0%);乙肝五项(HBV-M)不同组合模式中,HBsAg、HBeAb、HBcAb三项阳性(小三阳)20例,HBsAg、HBeAg、HBcAb阳性(大三阳)9例,HBsAg、HBcAb两项阳性14例。AFP、CA19-9、CA125、CEA对肝癌诊断的灵敏度依次为AFP(68.0%),CA19-9(34.6%),CA125(33.3%),CEA(30.7%),四项联合检测对肝癌诊断的灵敏度可提高至80.0%。结论肝癌的发生与HBV有着非常密切的关系,HBsAg、HBeAb、HBcAb三项阳性(小三阳)患者应视为的高危人群。在肝癌患者中,肝癌的单项肿瘤标志物检测应首选阳性率最高的AFP,多种肿瘤标志物联合检测对肝癌的诊断具有重要价值。     

原发性肝癌肿瘤标志物的研究进展

原发性肝癌（primary hepatoeellular carcinoma，PHC）是我国常见的恶性肿瘤，占所有癌症的4％，其发病率和死亡率有逐年增高的趋势。对PHC的早期诊断和鉴别诊断一直是阻碍临床和研究的一大难题。甲胎蛋白（alpha-fetoprotein，AFP）多年来被作为诊断PHC的首选指标，使原发性肝癌得以早期诊断。随着科学技术的进展，肿瘤标志物的种类已扩展到包括蛋白类及基因类的标志物。本文就原发性肝癌肿瘤标志物的研究作一综述。     

肝细胞癌的相关血清标志物

肝细胞癌(HCC)的早期诊断是其治疗的关键,HCC血清标志物的检测为其诊断提供了有利的方法,并且操作简单,敏感性高、特异性强。目前常用的血清标志物为AFP、AFPvariants、AFPmRNA、AFU、GGT、DCP、AIF、GPC3等。这些标志物的联合使用有助于HCC的诊断及预后判断。     

肝细胞癌的相关血清标志物

HCC的早期诊断是其治疗的关键，HCC血清标志物的检测又为其诊断提供了有利的途径，并且操作简单，敏感性高和特异性强。目前常用的血清标志物为AFP、AFP变异体、AFP mRNA、AFU、GGT、DCP、AIF、GPC3等。这些标志物的联合使用有助于HCC的诊断及预后。     

肝癌早期血清标志物研究的新进展

肝细胞癌是世界范围最常见的恶性肿瘤之一,死亡率位居世界肿瘤死亡第二位,肿瘤标志物是诊断早期肝癌的有效手段之一。近年来各种新的肿瘤标志研究进展迅速,在诊断肝癌的敏感度、特异度或复发和预后的判断等方面各具优势,本文就以上最具代表性的肝癌标志物研究新进展进行综述。     

多项肿瘤标志物对AFP阴性低浓度肝癌的论断价值

本文对６５例肝癌、５４例良性肝病进行ＨＡＧ１８、ＬＣＡ－ＡＡＴ、ＳＦ及β２－ＭＧ的血清学检测，发现在ＡＦＰ阴性低浓度肝癌中，单项标志物的敏感度以ＳＦ最高（７０％－８８．２％），ＨＡｇ１８最低（７０％－７６．５％），特异性及诊断效率均以ＬＣＡ－ＡＡＴ最高（７３．５％－８１．８％和４９．１％－６０．６％），β２－ＭＧ最低（４５．５％－６１．８％和３１．８％－５０．９％）。多项标志物的敏感度、特异性及诊     

血清高尔基体蛋白73联合甲胎蛋白检测在原发性肝癌患者中的诊断价值

目的：探讨高尔基体蛋白73（golgiprotein 73,GP73）联合甲胎蛋白检测用于原发性肝癌诊断的临床意义。方法：收集2013年6 月至9 月天津医科大学肿瘤医院160 例血清,其中原发性肝癌患者46例,单纯肝硬化患者30例,其他消化系统肿瘤患者44例,健康者40例。应用酶联免疫吸附实验定量检测血清GP73水平,电化学发光免疫分析检测血清甲胎蛋白（alpha-fetoprotein ,AFP）水平。结果：GP73诊断原发性肝癌的敏感性达到73.9% ,与本研究中AFP 敏感性（56.5%）相比,前者有显著增高,差异有统计学意义（P<0.01）。 GP73和AFP 联合检测敏感性有显著提高,可以达到86.9% ,与单独一种相比敏感性有显著性差异（P<0.01）。 结论：GP73有可能作为原发性肝癌诊断的血清标志物之一,而GP73和AFP 的联合检测对原发性肝癌的诊断也有较好的应用价值。     

Hepatic resection for a hepatocellular carcinoma larger than 10 cm.

Twenty-one patients with hepatocellular carcinoma (HCC) larger than 10 cm diameter were treated during the 18 year period from 1971 to 1988. The mean tumor size was 13 cm (range 10-18 cm). Nineteen patients (90.5%) had subjective symptoms. Eight patients (38.1%) had alpha-fetoprotein (AFP) levels over 10,000 ng/ml, and in 18 patients (85.7%) the levels were over 20 ng/ml. Nevertheless, only three (14.3%) were detected by AFP. Scintigraphy before 1981 and ultrasonography after 1982 appears to be most helpful for detection of HCC. Nineteen lesions (90.5%) were localized in the right hepatic lobe. Large HCC showed a low incidence of histologically verified concomitant cirrhosis (33%; 7 of 21) and a relatively well preserved hepatocellular function (indocyanine green test; 13.9 +/- 6.6%). Curative resection could be done for all 21 patients. There were three (14.3%) operative deaths. The 1-, 3-, and 5-year survival rates were 72.2, 32.9, and 8.2%, respectively. One patient who underwent a left hepatic lobectomy has survived for over 5 years, with recurrence. There were 14 recurrences (66.7%) in 21 patients: 11 were hepatic and three were in the lungs. In patients with large HCC, surgical resection should be done, provided the clinical status and hepatocellular reserves are adequate.     

肿瘤标志物联合检测对原发性肝癌的诊断价值

目的:探讨肿瘤标志物（testing multi-tumor,TM）联合检测对原发性肝癌的诊断价值。方法:应用电化学发光法定量测定46例原发性肝癌患者、32例良性肝病患者、40例健康体检者血清中糖类抗原199（CA-199）、神经特异性烯醇酶（NSE）、癌胚抗原（CEA）、糖类抗原242（CA-242）、血清铁蛋白（FERR）、人绒毛膜促性腺激素（HCG）、甲胎蛋白（AFP）、游离前列腺特异性抗原（FPSA）、前列腺特异抗原（TPSA）、糖类抗原125（CA-125）、生长激素（HGH）、糖类抗原153（CA-153）12种TM的浓度。结果:肝癌组CA-199、CEA、CA-242、Ferritin、AFP、CA-153阳性率相对于良性肝病组及健康对照组显著增高（P<0.01）;肝癌组CA-199、CEA、CA-242、Ferritin、AFP、CA-153联合检测相对于健康对照组阳性率及敏感性显著增高（P<0.01）。结论:CA-199、CEA、CA-242、Ferritin、AFP、CA-153联合检测有助于提高原发性肝癌阳性检出率。     

肾细胞癌相关分子标志物研究现状及进展

近年,有关肾细胞癌病理学、遗传性及分子生物学方面的研究取得显著进展,这对提高肾细胞癌早期诊断、预后判断及治疗水平有重要意义。目前研究的多个肾细胞癌相关分子标志物(如CAⅨ、B7-H1等)对于肾细胞癌患者的预后判断有一定意义。本文总结了近年来与肾细胞癌患者有关的肿瘤标志物,分析其与肾细胞癌的诊断、治疗和预后方面关系。     

An apparent danazol-induced primary hepatocellular carcinoma: case report

This paper presents an apparent case of danazol-induced primary hepatocellular carcinoma in a 49-year-old patient, following two years of continuous therapy with this inhibitor of pituitary gonadotrophin. Discontinuation of the drug failed to cause regression of the tumour.     

Prediction of vascular invasion in hepatocellular carcinoma by next-generation des-r-carboxy prothrombin

Background:

In hepatocellular carcinoma (HCC), des-r-carboxy prothrombin (DCP) more accurately reflects the malignant potential than alpha-fetoprotein (AFP). Next-generation DCP (NX-DCP) was created to overcome some of the limitations of conventional DCP. This study assessed the predictive value of NX-DCP for vascular invasion in HCC.

Methods:

We prospectively studied 82 consecutive patients who were scheduled to undergo resection for HCC. Patients were divided into two groups according to the presence or absence of pathological vascular invasion. The predictive powers of AFP, conventional DCP, and NX-DCP for vascular invasion were compared by receiver operating characteristic curve analysis, and correlations with tumour markers and the presence of vascular invasion were assessed.

Results:

Vascular invasion was pathologically confirmed in 21 patients (positive group) and absent in 61 patients (negative group). The NX-DCP level was significantly higher in the positive group than in the negative group (510.0 mAU ml⁻¹ (10–98 450) vs 34.0 mAU ml⁻¹ (12–541), P<0.0001), while the AFP level did not differ significantly between the groups (9.7 ng ml⁻¹ (1.6–43 960.0) vs 11.0 ng ml⁻¹ (1.6–1650.0), P=0.49). The area under the curve (AUC) of NX-DCP (AUC=0.813, sensitivity=71.4%, 1−specificity=13.1%) had good sensitivity for the prediction of vascular invasion, while the AUC of AFP was 0.550 (sensitivity=28.6%, 1−specificity=1.60%). The suitable cutoff value for identifying pathological vascular invasion in HCC was 33 mm (AUC: 0.783, sensitivity=71.43%, 1−specificity=11.48%).

Conclusions:

The NX-DCP level can be used to predict the presence of vascular invasion in HCC.     

肾细胞癌的相关标志物

肾细胞癌是成年人肾脏最常见的恶性肿瘤,其自然过程极难预料,仅依靠分期和分级等尚不能提供足够的预后信息.寻找适合的肿瘤标志物有助于该病的诊断和监测,提供更有效的预后信息,确定发生复发和转移的风险,甚至可以作为肿瘤靶向治疗的标靶,并有助于深入了解肾细胞癌的疾病发展过程和揭示与之有关的分子生物学信息.本文回顾分析了近年来RCC相关性肿瘤标志物的最新研究进展情况.