甲胎蛋白异质体3含量对早期肝癌的预后价值

目的 探讨甲胎蛋白异质体3(lentil lectin-reactive alpha-fetoprotein-L3,AFP-L3)的含量对早期肝癌的预后价值.方法 97例早期肝癌患者根据术前AFP和AFP-13的含量分为:(1)AFP阳性、AFP-L3阴性组(29例):AFP＞20 μg/L & AFP-13＜15%;(2)AFP-L3、AFP均低含量组(16例):15%≤AFP-L3≤50% & 20 μg/L≤AFP≤200 μg/L;(3)AFP-L3、AFP均高含量组(13例):AFP-L3＞50% & AFP＞200 μg/L;(4)AFP-L3高含量、AFP低含量组(24例):AFP-13＞50%& 20 μg/L≤AFP≤200 μg/L;(5)AFP-L3低含量、AFP高含量组(15例):15%≤AFP-L3≤50% & AFP＞200 μg/L.对各组患者的肿瘤分化程度、术后1、2、3年生存率和无瘤生存率进行分析.结果 AFP-13阴性患者的肿瘤分化程度、术后3年生存率和无瘤牛存率明显优于AFP-L3阳性患者(χ2=21.051,10.043,4.450,6.977,25.566,P＜0.05).AFP-L3高含量组患者的肿瘤分化程度、术后1、2、3年生存率和无瘤生存率明显低于低含量组(χ2=7.938,3.488,9.085,P＜0.05).结论 AFP-L3含量的增高提示肿瘤恶性程度高,预后不良,尤其是AFP水平低时.手术前后检测AFP-L3含量对于患者预后的评价具有指导意义.     

肿瘤标志物在肝细胞癌合并门静脉癌栓诊断中的意义

目的:分析肿瘤标志物在肝细胞癌合并门静脉癌栓诊断中的意义.方法:回顾性分析1993年1月-2011年1月经影像学诊断为肝细胞癌并门静脉癌栓患者475例,同时随机选取同期经影像学诊断为肝细胞癌的手术患者977例.将甲胎蛋白(AFP)、癌胚抗原(CEA)、CA125作为实验因素.结果:2组一般情况差异无统计学意义(P＞0.05). ROC分析结果显示AFP、CA125的AUC面积分别达到0.814、0.783,AFP诊断界数值为32.91 ng/mL,CA125为113.65 U/mL.两者并联敏感性为0.909,特异性为0.410;串联时敏感性为0.520,特异性为0.970.当肝细胞癌患者满足AFP≥20 000 ng/mL时,其诊断敏感性为0.24,特异性为0.96,准确性为0.73,筛检阳性率0.76.结论:在检测肝细胞癌合并门静脉癌栓中尚无敏感性和特异性均令人满意的肿瘤标志物,AFP和CA125水平的检测对临床实践中判断是否合并门静脉癌栓有一定的指导意义.     

甲胎蛋白低浓度阳性肝细胞癌424例的诊断分析

目的：探讨在有肝实质占位病变（space occuping lesion，SOL）时甲胎蛋白（AFP）低浓度阳性（AFP21-200цg/L）肝细胞癌（HCC）患者的临床诊断。方法：应用随机对照临床试验的方法对1993年1月至2001年6月经手术和病理学证实的2878例肝SOL进行临床流行病学分析。结果；HCC组和非HCC组AFP的敏感性是69.9%(1650/2362)和8.9%(46/516)，特异性是91.1%(470/516)和30.1%(712/2362)，阳性预测值是97.3%(1650/1696)和2.7%(46/1696)，P值均小于0.01。结论：（1）在有肝SOL存在时，AFP低浓度升高也有重要诊断价值，并不需要等待AFP大于200或500цg/L才能诊断HCC；（2）提出低甲胎蛋白浓度HCC的概念有利于在AFP较低浓度时作出HCC的早期诊断，可减少18?P21-200Цg/L HCC患者的漏诊；（3）用AFP大于20цg/L结合B型超声、CT等联合诊断，提高了单一诊断手段的敏感性和特异性。     

肝细胞癌患者外周血甲胎蛋白mRNA与单核细胞端粒酶活性检测

目的探讨外周血甲胎蛋白(AFP)mRNA和外周血单核细胞(PBMC)端粒酶活性的检测在肝细胞癌(HCC)诊断中的意义。方法采用巢式逆转录PCR(Nest RT-PCR)法检测HCC、肝脏良性肿瘤、慢性肝病患者及正常人外周血的AFP mRNA表达,聚合酶链反应-酶联免疫吸附测定(PCR-ELISA)检测PBMC的端粒酶活性。结果 (1)AFP mRNA在HCC外周血中阳性率为73.3%(22/30),在肝脏良性肿瘤、慢性肝病患者及正常人外周血中无表达(分别为0/10,0/30,0/30),(均P0.001)。(2)HCC患者PBMC端粒酶活性的阳性率(93.3%,28/30)显著高于肝脏良性肿瘤患者(40%,4/10)和慢性肝病患者(6.7%,2/30)及正常人(0),(分别P0.01,0.001,0.001)。(3)外周血AFP mRNA与HCC PBMC的端粒酶活性表达呈显著正相关(r=0.6742,P0.05)。结论 AFP mRNA是外周血HCC细胞的特异性标志物;端粒酶活性的检测具有更高的敏感性;两者的联合检测具有重要的临床意义。     

多种血清肿瘤标志物联合检测在原发性肝癌诊断中的应用研究

目的 探究多种血清肿瘤标志物联合检测在原发性肝癌诊断中的应用效果。方法 选取2019年1月至2021年12月在梧州市工人医院接受治疗的原发性肝癌、良性肝脏疾病及非肝脏疾病患者105例,根据疾病不同分别纳入肝癌组、良性肝病组、对照组各35例。检测三组患者血清中异常凝血酶原（Desg-carboxyl prothrombin,DCP）、甲胎蛋白（alpha-fetoprotein,AFP）、α-L-岩藻糖苷酶(α-L-fucosidase,AFU）、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)的水平,评价以上指标单独与联合诊断价值。结果 肝癌组患者的DCP、AFP、AFU、CA19-9水平均高于其他两组,且组间对比存在显著差异（P <0.05）。经受试者操作特征曲线分析,血清DCP、AFP、AFU、CA19-9的最佳诊断界值分别为39.38mAU/ml、48.35μg/L、25.93U/L、50.54U/ml,AFP+AFU与DCP+AFP+AFU的串联试验的约登指数最大,为0.757。结论 血清DCP、AFP、AFU、CA19-9单独检测与不...     

甲胎蛋白低浓度阳性细胞癌

目的：介绍甲胎蛋白（AFP）低浓度阳性肝细胞癌（HCC）的临床诊断特点。方法：复习相关文献,作综合性报道,结果与结论：（1）在有肝实质占位病变（SOL）存在时,AFP低浓度升高可作为诊断HCC的参考标准;（2）提出低浓度AFP HCC,。有助于避免AFP 21－200ug/L之间HCC的漏诊,利于在AFP较低浓度时作出早期诊断。（3）用AFP＞20ug/L结合B超,CT等检查联合进行诊断,提高了单一诊断手段的敏感性和特异性。     

GP73联合AFP检测价值及肝细胞癌早期诊断和复发监测的研究进展

甲胎蛋白（AFP）是临床上诊断肝细胞癌几乎惟一可用的血清标志物,其诊断准确率并不理想;高尔基体糖蛋白73（GP73）是当前被认为是肝细胞癌早期诊断的一个新的血清学肿瘤标志物。笔者就GP73及AFP两种肿瘤标记物的联合检测对肝细胞癌早期诊断和复发监测的应用价值的研究进展进行综述。

     

血清高尔基体膜蛋白73在原发性肝细胞癌早期诊断中的应用

目的:探讨原发性肝细胞癌患者血清中高尔基体膜蛋白-73(GP73)的表达水平及其早期诊断价值。方法:选择我院2012年10月—2014年10月门诊、住院患者和健康体检人群,分别用酶联免疫吸附法和化学发光免疫分析法检测63例原发性肝细胞癌、56例肝硬化、87例慢性乙型肝炎、48例其他恶性肿瘤、58例健康对照组血清GP73与甲胎蛋白(AFP)水平,分析两指标各组间差别,绘制其诊断原发性肝细胞癌的ROC曲线。结果:GP73在不同年龄、性别、肿瘤大小间及不同AFP浓度的表达差异无统计学意义,GP73、AFP在原发性肝细胞癌鉴别诊断的ROC曲线下面积分别为0.808、0.758。GP73诊断PHC组敏感性及特异性分别为88.6%,92.1%,均显著高于AFP。结论:血清GP73对原发性肝细胞癌的诊断价值优于AFP,有望成为原发性肝细胞癌早期诊断的血清标记物。     

甲胎蛋白阳性胃癌12例分析

众所周知，甲胎蛋白（AFP）是肝细胞癌、畸胎瘤、卵黄囊瘤等多种原发恶性肿瘤的标志物，但近期研究发现胃癌也可以产生AFP，分泌AFP的胃癌，被称为甲胎蛋白阳性胃癌（AFPGC）。据文献报道，AFPGC在临床特性、生物学行为和预后等方面不同于AFP阴性胃癌。现对北京大学人民医院2003年1月至2006年9月收治的376例胃癌患者临床资料进行回顾分析，总结如下。     

联合检测AFP、CA199和GGTⅡ对诊断原发性肝细胞癌的临床价值

目的探讨甲胎蛋白(AFP)、癌抗原125(CA125)及ɑ-谷氨酰转肽酶同功酶Ⅱ(GGTⅡ)三种标志物联合检测对原发性肝细胞癌(hepatocellular carcinoma,HCC)患者的诊断价值。方法 HCC未手术组患者80例,肝良性病变组患者54例,HCC手术组35例。采用双抗体夹心原理(ELISA)检测人血清中的AFP和CA125,特异免疫膜吸附法检测血清中的GGTⅡ水平。结果 HCC未手术组血清中AFP、CA125及GGTⅡ水平高于肝良性病变组,差异有统计学意义(P﹤0.01)。HCC手术组术后三者的血清水平均低于HCC未手术组,差异有统计学意义(P﹤0.01)。3种指标联合检测对于HCC的诊断,灵敏度和准确度有所提高,但特异性有所下降。结论联合检测AFP、CA125及GGTⅡ可以提高肿瘤标志物对HCC的临床诊断价值。     

Significance of Alpha-Fetoprotein and Des-γ-Carboxy Prothrombin in Patients with Hepatocellular Carcinoma Undergoing Hepatectomy

Background  

Alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) are well-known tumor markers of hepatocellular carcinoma (HCC). The aims of this study are to calculate the sensitivity/specificity of AFP and DCP measurement for the diagnosis of HCC, measure response rates of the markers following curative-intent resections, determine the correlations between the marker levels and clinicopathological prognostic variables, and determine the correlations between the marker levels before hepatectomy and those at diagnosis of recurrence.     

血清磷脂酰肌醇蛋白聚糖3蛋白测定在肝细胞癌诊断中的价值

目的检测血清中磷脂酰肌醇蛋白聚糖3(Glypican-3,GPC3)的浓度,探讨其对原发性肝细胞癌(HCC)的诊断价值。方法用酶链免疫吸附试验(ELISA)对67例HCC患者、41例肝硬化患者、30例健康者血清中GPC3进行测定,化学发光法检测甲胎蛋白(AFP)。结果 HCC患者血清GPC3平均浓度为(10.85±0.58)μg/L;肝硬化患者血清GPC3平均浓度为(2.45±0.61)μg/L;健康者血清GPC3平均浓度为(1.14±0.22)μg/L。HCC患者血清GPC3浓度明显高于肝硬化患者和健康者(H=327.000,P=0.0001),肝硬化患者与健康者差异无统计学意义(Z=0.792,P=0.429)。当以3μg/L为诊断界值时,GPC3对HCC的敏感性和特异性分别为88.1%和85.9%。当AFP以20μg/L为诊断界值时,其对HCC的敏感性和特异性分别为65.7%和76.2%。GPC3对HCC的敏感性显著高于AFP(χ2=10.995,P=0.001)。在23例AFP阴性的HCC患者中有17例GPC3阳性,阳性率为73.9%(17/23)。GPC3的ROC曲线下面积大于AFP(0.898vs0.814)。结论血清GPC3对HCC有很高的敏感性和特异性,可作为一种新的肿瘤标志物用于HCC的诊断。     

血清肿瘤标记物联合检测鉴别肝内胆管癌和肝细胞癌

目的：研究评价肝内胆管癌（ICC）和肝细胞癌（HCC）患者血清胸苷激酶1（TK1）、甲胎蛋白（AFP）、糖类抗原19-9（CA19-9）和癌胚抗原（CEA）的表达。方法：应用化学增强发光点印迹法定量检测48例HCC患者和17例ICC患者血清TK1浓度,直接化学发光法检测血清AFP、CA19-9和CEA浓度;50例健康志愿者作为对照组。结果：血清TK1、AFP、CAl9-9和CEA浓度在HCC组和ICC组均明显升高（P＜0.05）。血清CA19-9对ICC诊断敏感性最高（76.5%）,CEA其次（64.7%）。结论：血清TK1、AFP、CA19-9和CEA联合检测对HCC和ICC的鉴别诊断具有一定临床意义。     

血清肝纤维化指标与肝纤维化病理改变的相关性研究

目的：研究血清中透明质酸（HA）、层粘连蛋白（LN）、三型前胶原N端肽（PⅢNP）及Ⅳ型胶原（CⅣ）等肝纤维化指标的水平与肝纤维化分期的相关性,探讨其在乙型肝炎患者肝纤维化非创伤性诊断中的临床应用价值。方法采用放射免疫分析法检测172例乙型病毒性肝炎患者血清中HA、LN、PⅢNP和CⅣ的含量,以肝组织活检作为“金标准”,评价肝纤维化指标与肝纤维化分期的相关性及其用于鉴别明显肝纤维化的诊断价值。结果血清中肝纤维化指标的含量与肝纤维化分期呈正相关,相关系数由高至低分别为HA（r =0.687）、PⅢNP（r =0.490）、CⅣ（r =0.406）和LN（r =0.392）;自S2期开始,以上4项指标的水平均显著升高,与S0、S1期比较差异具有统计学意义（P ＜0.05）;轻度肝纤维化（S0～S1）和明显肝纤维化（S2～S4）两组间4项指标的差异均有统计学意义（P ＜0.05）;ROC曲线显示：单项指标预测明显肝纤维化时,AUC由高至低分别为HA（0.846）、PⅢNP（0.786）、CⅣ（0.747）和LN（0.638）;敏感性分别为LN（Se =80.57%）、HA（Se =75.16%）、CⅣ（Se =73.38%）和PⅢNP（Se =69.54%）,特异性分别为HA（Spe =90.25%）、PⅢNP（Spe =81.89%）、CⅣ（Spe =71.51%）和LN（Spe =65.50%）,准确性分别为HA（83.18%）、PⅢNP（75.74%）、LN（68.46%）和CⅣ（62.53%）。4项指标联合检查,诊断的敏感性降低（Se =68.85%）,特异性提高（Spe =92.96%）,诊断准确率提高至86.44%。结论单个指标检查中,HA是诊断肝纤维化最有价值的一项,4项指标联合检查可提高诊断的特异性和准确度。     

Lectin-reactive alpha-fetoprotein as a marker for testicular tumor activity

BACKGROUND: Lens culinaris agglutin (LCA)-affinity electrophoresis resolves serum alpha-fetoprotein (AFP) into three isoforms, AFP-L1, -L2 and -L3. The ratio of AFP-L3 to total AFP (AFP-L3%) is frequently high in hepatocellular carcinoma (HCC) patients, and thus, it is widely used for early diagnosis of HCC. In the present study, we used the subfraction profile of LCA-binding AFP to diagnose and monitor testicular tumor activity. METHODS: Serum samples were collected from 21 testicular tumor patients, and the LCA-reactive fractions were determined by LCA-affinity electrophoresis coupled with antibody-affinity blotting. The histological diagnosis was non-seminomatous germ cell tumor (NSGCT) in 15 patients and pure seminoma in six patients. RESULTS: Serum AFP levels were abnormally elevated (>20 ng/mL) in 10 of 15 NSGCT patients. One NSGCT patient and two seminoma patients showed borderline AFP levels between 10 and 20 ng/mL. LCA-reactive AFP was detected in all 11 NSGCT patients with serum AFP levels above 10 ng/mL, but not in the two seminoma patients with serum AFP levels above 10 ng/mL. In testicular tumor patients, the broad band of AFP-L2 could not be completely separated from AFP-L3. The mean ratio of AFP-L3 plus AFP-L2 (AFP-L2 + 3%) was as high as 94% (range 80-99%) in these patients. Serial determinations of LCA-reactive fractions were performed in eight of the 11 LCA-reactive AFP-positive patients. They included five patients who received chemotherapy, and three patients who underwent orchiectomy for stage I NSGCT. In three of eight patients, LCA-reactive AFP was detected even after normalization of total AFP levels. All three patients relapsed, with elevation of serum AFP within several months. CONCLUSION: Determination of LCA-reactive AFP might be a useful marker for testicular tumor activity in patients with lower AFP levels.     

荧光定量PCR法扩增MAGE-1、MAGE-3及AFP基因联合检测肝癌病人外周血微小转移

目的探讨MAGE-1、MAGE-3和AFP mRNA联合检测肝癌病人外周血中微小转移的临床意义。方法应用荧光定量聚合酶链反应（FQ-PCR）检测86例原发性肝癌病人肝癌组织和外周血中MAGE-1、MAGE-3和AFP mRNA的表达。结果86例原发性肝癌病人肝癌组织中MAGE-1、MAGE-3和AFP mRNA的阳性率分别为34．9％（30／86）、60．5％（52／86）和69．8％（60／86）；所有病人肝癌组织至少表达其中一种mRNA。外周血中阳性率分别为14．0％（12／86）、20．1％（18／86）和33．7％（29／86）。52．3％（45／86）的病人外周血至少检测到一种mRNA，较单一AFP mRNA检测阳性率明显提高（P〈0．05）。25例肝炎肝硬化病人及28例健康志愿者中未见阳性。阳性率与肿瘤TNM分期、门脉瘤栓、远处转移有关（P〈0．05）。与肿瘤大小、数目、分化程度、血清AFP水平无关（P〉0．05）。结论MAGE-1、MAGE-3结合AFP mRNA联合检测肝癌血行微小转移较单一AFP mRNA检测灵敏度高。     

Perspectives on using des-γ-carboxyprothrombin (DCP) as a serum biomarker: facilitating early detection of hepatocellular carcinoma in China

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths in China. Evidence has shown that surgical resection and liver transplantation may offer the best potential for treating HCC but are only available to patients whose tumors are detected early. Over the past few decades, although a series of measures for standardized management of HCC has been implemented in China, most patients with HCC in China still present with advanced-stage disease, thus strategies to screen for and diagnose HCC at an earlier stage are urgently needed in China when curable interventions can be offered to achieve long-term disease-free survival for patients with HCC. In China, the serum biomarker α-fetoprotein (AFP) is considered a useful and feasible tool for HCC screening and early diagnosis. However, the sensitivity and specificity of AFP vary widely, and the total AFP is not always specific, especially when HCC is in its early stages. Globally, numerous studies have reported that the combination of des-γ-carboxyprothrombin (DCP) and AFP may have a higher sensitivity than AFP alone, and suggested DCP could also be used to assess the progression of HCC. However, DCP has not been approved in China until now. Differ from most of Western countries, people with HBV infection are the largest population at risk of developing HCC China. In order to assess the screening and diagnostic value of DCP in Chinese patients with HCC, a first large-scale, multi-center study was launched in China in 2012, results showed that DCP can help to detect HCC in its early stages and facilitate definitive treatment. The clinical use of DCP is urgently needed to facilitate early detection of HCC in China.Key Words: Liver cancer, tumor marker, des-γ-carboxyprothrombin (DCP), α-fetoprotein (AFP), screeningHepatocellular carcinoma (HCC) is the most common type of liver cancer, accounting for 80-90% of all cases. Asian countries account for 75-80% of the 650,000 HCC cases reported globally each year; of particular note is the fact that China alone accounts for 55% of HCC cases worldwide (1). Currently, HCC ranks as the second leading cause of cancer-related deaths in males and the third leading cause of cancer-related deaths in females in China, with a total mortality rate of 26.26/100,000. Moreover, the incidence of HCC has increased over the past decades, and now it is the second most common cancer in urban areas and the most common in rural areas of China, with a total prevalence of 26-32/10,000 and a prevalence as high as 70-80/10,000 in some areas (2,3).Evidence has shown that surgical resection and liver transplantation may offer the best potential for treating HCC but are only available to patients whose tumors are detected early. The overall 5-year survival rate is 40%, but liver resection to treat early HCC could lead to a 5-year survival rate of 60-70% (4-6). Over the past few decades, a series of measures for standardized management of HCC has been implemented by the Chinese Government, and the Chinese Guidelines on HCC—Expert Consensus on the Treatment Standards for Hepatic Carcinoma—were drafted in 2009 (7). Currently, standard treatment in China is comprehensive therapy predominantly in the form of surgery. As clinical techniques have developed in China, new techniques have also become available, such as laparoscopic surgery and minimally invasive robotic surgery. However, most patients with HCC in China still present with advanced-stage disease (8), thus reducing the chance of curative treatment. Accordingly, strategies to screen for and diagnose HCC at an earlier stage are urgently needed in China when curable interventions can be offered to achieve long-term disease-free survival for patients with HCC (9).Several cohort studies have shown that screening high-risk populations with HBV- or HCV-related chronic liver disease improves the rate of early HCC detection and the rate of curative treatment (10-12), and such screening is also recommended by many HCC guidelines worldwide, including the guidelines established by the American Association for the Study of Liver Disease (AASLD), the National Comprehensive Cancer Network (NCCN), and the Asian Pacific Association for the Study of the Liver (APASL). Unlike in the United States, Europe, and other Asian countries such as Japan where HCV is the most significant etiological factor for developing HCC, in China approximately 85% of HCC cases are HBV-related while only 10% of cases are HCV-related and a small minority involve HBV and HCV (2,3). Thus, people with HBV infection are the largest population at risk of developing HCC in China. In fact, 93 million Chinese are HBV carriers, accounting for 2/3 of such patients worldwide, and about 20 million of these individuals have chronic HBV infection.In Asia, Japan and South Korea have implemented a nationwide screening and surveillance program for populations at risk of developing HCC (13). According to the HCC Guidelines in Japan, ultrasonography and measurement of α-fetoprotein (AFP), the lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), or des-γ-carboxyprothrombin (DCP) should be performed at intervals of 3-4 months in the highest-risk group (patients with HBV- or HCV-related liver cirrhosis) and at 6-month intervals in the high-risk group (patients with HBV- or HCV-related chronic liver disease or liver cirrhosis due to other causes) (14,15). Currently, AFP, AFP-L3, and DCP are widely and routinely used to screen for HCC in Japan, and these tests are covered by Japan’s national health insurance as serological biomarkers to screen for HCC in clinical settings. Since most high-risk patients were closely followed before developing HCC, HCC nodules were detected in the early stage in more than 60% of patients in Japan (16).Similarly, Taiwan also established a screening and surveillance program to screen patients with cirrhosis every 3-6 months and patients with no cirrhosis every 6-12 months. However, there is no government-funded screening and surveillance program to screen for HCC in high-risk populations in Hong Kong or other parts of China. Thus, a well-considered strategy of screening high-risk populations with HBV-related chronic liver disease is urgently needed in China to facilitate the early detection of HCC.The Chinese Guidelines on HCC recommend that ultrasonography and AFP measurement be performed every 6 months for the population ages 35-40 at risk of developing HCC (17). Ultrasound is the imaging tool most often used to screen for and diagnose HCC because it is simple, inexpensive, non-invasive, and allows real-time observation. However, the success of ultrasound depends on the expertise of the physician, the ultrasound equipment available, and the echo texture of the liver, so the actual sensitivity of ultrasound is difficult to assess due to the lack of a definitive standard for HCC (18,19). In China, the serum biomarker AFP is considered a useful and feasible tool for HCC screening and early diagnosis. The clinical usefulness of AFP in China has been confirmed by a randomized controlled trial in 2004 that involved 18,816 Chinese patients (20). However, the sensitivity and specificity of AFP vary widely, and the total AFP is not always specific, especially when HCC is in its early stages. AFP has been found to have a sensitivity of 41-65% and specificity of 80-90% when detecting HCC given an AFP cut-off of 20 ng/mL, but an important fact to remember is that up to 50% of patients with HCC have an AFP level below 20 ng/mL, and elevated levels of AFP are also found in patients with liver diseases other than HCC, including viral hepatitis, at a rate of 10-42% (21,22). In addition, many factors hamper HCC diagnosis in clinical practice. Some patients may have high levels of AFP but no space-occupying lesions according to imaging while others may test negative for AFP but have lesions smaller than 1 cm or no characteristic lesions according to imaging. Thus, AFP cannot be used as the sole tool to screen for and diagnose HCC.The clinical usefulness of serum DCP levels to screen for and diagnose HCC has been noted since 1984. Numerous studies have reported that the combination of DCP and AFP has a sensitivity of 84% and a specificity of 83% and that the combination of DCP and AFP-L3 has a sensitivity of 89.5-89.8% and a specificity of 41.7-66.7% when detecting small HCC ≤3 cm in size (23-26). Moreover, many studies have suggested that DCP could also be used to assess the progression of HCC, possibly serving as an indicator of HCC recurrence after curative therapy, as a good predictor of the presence of vascular invasion and as a way to select recipients of liver transplants, and as a key to the development of new chemotherapeutic strategies to treat HCC (16). However, DCP is currently approved in Japan, Korea and Indonesia (27), it has not been approved in China until now.According to evidence-based medicine (EBM), systematic evaluation needs to be performed to assess the screening and diagnostic value of DCP in Chinese patients with HCC, and large-scale, multi-center studies need to be performed to provide strong supporting data. Accordingly, the current authors and their colleagues launched a project in 2012 to systematically evaluate the usefulness of DCP in early detection of HCC in China. This project involved retrospective studies as well as a prospective study involving four noted hospitals in Chongqing, Beijing, and Tianjin. This is the first large-scale, multi-center study of DCP’s usefulness in detecting early HCC performed in China. According to the current research results involving 336 patients with HCC and 252 patients with liver diseases other than HCC conducted in the Southwest Hospital, Third Military Medical University in Chongqing (Figure 1), there is no significant correlation between serum levels of DCP and AFP (R²=0.0179); DCP had a total sensitivity of 74% while a combination of DCP and AFP had a sensitivity of 84%, which is higher than either DCP or AFP alone. Moreover, DCP resulted in a specificity of 56% with a cut-off value of 40 mAU/mL and 94% with a cut-off value of 100 mAU/mL (28).Open in a separate windowFigure 1The clinical usefulness of DCP in detecting HCC in Chinese patients. A. The sensitivity of AFP, DCP, and both combined; B. The relationship between AFP and DCP (Data are from a prospective study of 336 patients with HCC seen by the Southwest Hospital, Third Military Medical University in Chongqing)In conclusion, the current authors and their colleagues conducted the first large-scale, multi-center study to assess the clinical usefulness of DCP in Chinese patients with HCC. The prospective study conducted in one of centers showed that DCP can help to detect HCC in its early stages and facilitate definitive treatment. The clinical use of DCP is urgently needed to facilitate early detection of HCC. This is especially true for China, which accounts for 55% of HCC cases worldwide.     

Diagnosis of skeletal metastases by serum tumor markers]

Levels of serum tumor markers including CEA, AFP, CA 15-3, CA 19-9, CA 125 and TPA were measured in 26 patients with bone metastases and in 9 patients with primary bone tumors. TPA was the most sensitive marker to detect skeletal metastasis being elevated in 15 of the 22 patients (68.2%). High sensitivity was observed in CEA (46.1%), CA 15-3 (40%), and CA 125 (35%), and AFP showed relatively low sensitivity (4.3%). When elevation of TPA only or elevation of more than two tumor markers including TPA was used as a screening test for skeletal metastasis, over-all sensitivity, specificity, and accuracy were 73.1%, 88.9%, and 81% respectively. No definite correlation between the markers could be seen in this study. A combination of serum tumor markers was useful in the differential diagnosis of bone metastases from primary bone lesions. However, organ specificity of the markers were relatively low.