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。     

原发性肝细胞癌及癌旁组织中环氧合酶-2的表达及其意义

目的：研究人原发性肝细胞癌（HCC）组织和癌旁非瘤组织中的环氧合酶－2（COX－2）蛋白及基因表达情况,方法：采用免疫组织化法和原位分子杂交法,研究27对原发性肝细胞癌及癌旁非肿瘤组织,5例正常肝组织中COX－2的蛋白和基因表达,结果：高分化HCC中COX－2蛋白表达显著高于中分化和低分化HCC（P分别＜0．05）以及癌旁组织和正常组织（P分别＜0．01）,癌旁组织的COX－2表达显著高于正常组织（P＜0．05）,癌旁组织,中分化和低分化HCC之间COX－2的表达强度差异无显著性（P＞0．05）,在COX－2蛋白阳性的肝癌细胞和癌旁肝细胞胸胞胞质中可见到COX－2mRNA呈阳性表达,结论：COX－2的过度表达可能参与了高分子HCC的致癌过程。     

癌-睾丸抗原GAGE基因mRNA在肝细胞癌的表达及临床意义

GAGE基因是Van den Eynde等应用细胞毒性T淋巴细胞（CTL）筛选法，从一黑色素瘤细胞株cDNA文库中筛选出的肿瘤抗原基因，它能在多种来源不同的肿瘤组织表达，而在正常组织的表达仅限于睾丸组织，因此属于癌-睾丸抗原（CT抗原）。本研究中采用逆转录聚合酶链反应（RT-PCR）技术检测肝细胞癌（HCC）组织及相应癌旁组织中GAGE基因mRNA4的表达情况，     

Plk1与Survivin蛋白在肝细胞癌中的表达及意义

目的探讨Plk1和凋亡抑制蛋白Survivin在HCC中表达情况,为临床诊断和治疗提供理论依据。方法采用免疫组化法检测100例肝细胞癌标本中Plk1、Survivin的表达。结果⑴肝细胞癌中,Survivin蛋白的表达明显高于癌旁正常组织（P〈0.05）,Survivin在肝细胞癌组织中的表达与患者性别、年龄、肿瘤分化程度、AFP表达及是否侵犯肝被膜均无关联（P〉0.05）。与HBsAg表达有关联（P〈0.05）。⑵肝细胞癌组织中,Plk1阳性表达明显高于癌旁正常组织（P〈0.05）;Plk1在肝细胞癌组织中的表达与患者性别、年龄、AFP表达、HBsAg表达及是否侵犯肝被膜均无关（P〉0.05）,与肿瘤分化程度相关（P〈0.05）。⑶肝细胞癌组织中,Plk1与Survivin表达呈正相关（P〈0.05）。结论 Plk1与Survivin的联合检测为肝细胞癌的诊断和治疗提供新的依据。     

血浆Runx3基因启动子甲基化检测诊断早期肝细胞癌的临床价值

目的探讨血浆Runt相关转录因子3（Runx3）基因启动子甲基化检测诊断早期肝细胞癌（HCC）的临床价值。方法采用DNA甲基化特异性PCR方法,检测81例HCC患者的癌组织、癌旁正常组织及血浆Runx3基因启动子异常甲基化情况。结果癌旁正常组织未发现Runx3异常甲基化现象;癌组织Runx3异常甲基化率43．2％（35／81）,血浆39．5％（32／81）;血浆Runx3甲基化改变与癌组织甲基化改变显著相关（P〈0．05）。Runx3基因异常甲基化与HCC患者的临床病理参数无显著相关性（P〉0．05）。结论血浆Runx3基因启动子甲基化检测对早期诊断HCC有一定参考价值。     

预测钇-90放射栓塞术治疗伴门静脉浸润的肝细胞癌反应的预后分层

【据《J Hepatol》2018年1月报道】题：预测钇-90放射栓塞术治疗伴门静脉浸润的肝细胞癌反应的预后分层（作者Spreafico C等）肝细胞癌（HCC）是全球性的健康问题,且很大比例伴有门静脉癌栓（PVTT）。钇-90经动脉放射栓塞术（TARE）是一种通过选择性动脉内注射微珠（Yttrium-90）所表现的一种短距离放射治疗,其特点是穿透性有限,对周围组织的损伤有限。对于伴有PVTT的HCC患者,在治疗上有很好的疗效。来自于意大利米兰国家肿瘤研究所的Spreafico等连续收集了6年中经TARE治疗伴PVTT的HCC患者共120例,     

Bax、Fas蛋白在原发性肝细胞癌组织中的表达及临床意义

目的探讨Bax和Fas蛋白表达在原发性肝细胞癌（HCC）发生、发展中的作用。方法采用免疫组化法检测56例HCC癌旁组织和癌组织中Bax和Fas蛋白表达,并分析两指标与HCC临床病理特征的关系及两指标间的相关性。结果 Bax蛋白在癌旁组织和HCC癌组织中的阳性表达率分别为21.4%（12/56）、66.1%（37/56）,P〈0.05（χ2=28.32）;Fas蛋白在癌旁组织和HCC癌组织中的阳性表达率分别为80.4%（45/56）、41.1%（23/56）,P〈0.05（χ2=21.42）。Bax、Fas蛋白在HCC癌组织中的表达无明显相关性,两者表达均与肿瘤分化程度相关（P〈0.05）,但与年龄、性别、肿瘤直径、是否伴有肝硬化无明显相关（P〉0.05）。结论 Bax、Fas蛋白异常表达可能通过不同途径参与HCC发生、发展。     

Shh信号通路在肝癌中的表达及与β-catenin的关系

目的探讨原发性肝细胞癌（Hepatocellular Carcinoma,HCC）中Sonic Hedgehog（Shh）信号通路基因和15-catenin的表达情况及其临床意义。方法采用免疫组织化学方法对49例HCC和相应癌旁肝组织中Glil和β-catenin蛋白表达。荧光定量PCR检测2个肝癌细胞系和正常肝细胞中相应基因mRNA的表达情况。结果免疫组化染色与RT-PCR示Glil在HCC组织中的阳性表达率为77．56％,而癌旁肝组织为40．82％,两者差异具有显著意义（P〈0．05）。β-catenin蛋白在HCC中的表达显著高于癌旁肝组织（P〈0．05）,且与Glil的表达呈正相关（r=0．594,P=0．000）。Glil和β-cateninmRNA在肝癌细胞株中高表达,在正常肝细胞中低表达（P〈0．05）。结论Glil和β-catenin在肝癌细胞中均过度表达,可能协同作用促进肝癌细胞异常增殖,参与HCC的发生和发展。     

肝细胞癌中耐药基因的表达及意义

目的通过对肝细胞癌（HCC）中3种耐药基因MDR1、MRP、GST-π的检测,探讨肝细胞癌中耐药基因的表达特点及临床意义。方法应用逆转录-聚合酶链反应（RT-PCR）技术检测3种耐药基因在51例肝细胞癌组织和10例正常肝组织中的表达。结果 （1）MDR1、MRP、GST-π在肝细胞癌中的表达分别为0.55±0.27、0.62±0.29、0.64±0.31,正常肝组织中的表达分别为0.23±0.10、0.25±0.07、0.26±0.12,耐药基因在肝细胞癌中的表达高于正常肝组织,差异具有统计学意义（P〈0.05）;（2）耐药基因的表达与肿瘤Edmondson分级呈正相关（P〈0.05）;（3）MRP与GST-π的表达相关。结论肝细胞癌中存在有原发性耐药的现象,且多种机制并存。MDR1、MRP、GST-π在肝细胞癌中有较高的表达。联合检测对制定科学有效的治疗方案有一定价值。     

原发性肝细胞癌患者组织中瘦素及其受体表达与临床病理特征的关系

目的检测瘦素（leptin）和瘦素受体（OB—R）在原发性肝细胞癌（HCC）患者癌及癌旁组织中mRNA和蛋自水平表达情况。方法应用RT-PCR和Westernblot方法检测leptin其受体在33例HCC患者癌及癌旁组织中mRNA和蛋白表达,并分析其与临床病理特征之间的关系。结果leptin和OB—RmRNA及蛋白在癌旁组织表达水平高于癌组织（P〈0．05）。leptin和OB—R的表达与各临床病理特征均无显著相关（P〉0．05）。结论leptin及OB-R在HCC患者的癌及癌旁组织中均表达。     

Potentiality of immunotherapy against hepatocellular carcinoma

Hepatocellular carcinoma(HCC),the predominant form of primary liver cancer,is the fifth most common cancer worldwide and the second leading cause of cancer-related death. Despite the high incidence,treatment options remain limited for advanced HCC,and as a result prognosis continues to be poor. Current therapeutic options,surgery,chemotherapy and radiotherapy,have only modest efficacy. New treatment modalities to prolong survival and to minimize the risk of adverse response are desperately needed for patients with advanced HCC. Tumor immunotherapy is a promising,novel treatment strategy that may lead to improvements in both treatment-associated toxicity and outcome. The strategies have developed in part through genomic studies that have yielded candidate target molecules and in part through basic biology studies that have defined the pathways and cell types regulating immune response. Here,we summarize the various types of HCC immunotherapy and argue that the newfound field of HCC immunotherapy might provide critical advantages in the effort to improve prognosis of patients with advanced HCC. Already several immunotherapies,such as tumor-associated antigen therapy,immune checkpoint inhibitors and cell transfer immunotherapy,have demonstrated safety and feasibility in HCC patients. Unfortunately,immunotherapy currently has low efficacy in advanced stage HCC patients; overcoming this chal lenge will place immunotherapy at the forefront of HCC treatment,possibly in the near future.     

Proton beam radiotherapy for patients with early-stage and advanced lung cancer: a narrative review with contemporary clinical recommendations

Although lung cancer rates are decreasing nationally, lung cancer remains the leading cause of cancer related death. Despite advancements in treatment and technology, overall survival (OS) for lung cancer remains poor. Proton beam therapy (PBT) is an advanced radiation therapy (RT) modality for treatment of lung cancer with the potential to achieve dose escalation to tumor while sparing critical structures due to higher target conformality. In early and late-stage non-small cell lung cancer (NSCLC), dosimetric studies demonstrated reduced doses to organs at risk (OARs) such as the lung, spinal cord, and heart, and clinical studies report limited toxicities with PBT, including hypofractionated regimens. In limited-stage SCLC, studies showed that regimens chemo RT including PBT were well tolerated, which may help optimize clinical outcomes. Improved toxicity profiles may be beneficial in post-operative radiotherapy, for which initial dosimetric and clinical data are encouraging. Sparing of OARs may also increase the proportion of patients able to complete reirradiation for recurrent disease. However, there are various challenges of using PBT including a higher financial burden on healthcare and limited data supporting its cost-effectiveness. Further studies are needed to identify subgroups that benefit from PBT based on prognostic factors, and to evaluate PBT combined with immunotherapy, in order to elucidate the benefit that PBT may offer future lung cancer patients.     

中晚期肝癌临床治疗进展

肝癌的发病隐匿,早期诊断困难,进展较快,临床上仅有不足30%的患者就诊时可获得手术治疗的机会,因此非手术疗法是中晚期肝癌的主要治疗方式。总结了几种主要的非手术治疗方式———血管介入治疗、分子靶向和化疗药物治疗、放疗以及局部消融治疗在肝癌治疗中的地位。认为尽管综合治疗已成为肝癌治疗的共识,但是他们在综合治疗中的地位及次序等仍未形成共识,还需要进行更多的临床研究,从而为中晚期肝癌患者的治疗提供更好的选择。     

肝细胞癌的综合介入治疗

肝细胞癌（HCC）是世界范围内第五大常见肿瘤,每年新增病例超过50万。由于HCC早期症状隐匿,大多数患者在确诊时已是中晚期,失去了接受治愈性治疗的机会。而中晚期HCC患者由于肝功能损伤及肿瘤进展致预后很差,目前,以肝动脉栓塞化疗术（TACE）为主的综合介入治疗已成为中晚期HCC的主要治疗方式。本文就HCC的综合介入治疗的最新进展综述如下。     

非手术治疗原发性肝癌研究进展

肝细胞癌（HCC）是世界范围内第五大常见肿瘤,为肿瘤相关死亡的第三大常见原因。由于HCC 早期症状隐匿,大多数患者在确诊时已是中晚期,失去了接受治愈性治疗的机会。目前,HCC的非手术治疗方法很多,包括介入栓塞化疗、消融、放射治疗、化疗和分子靶向治疗等。现有治疗方法的单独或组合应用已被证明能够控制肿瘤生长,延长生存时间,提高生活质量。     

Role of stereotactic body radiation therapy for hepatocellular carcinoma

The integration of new technologies has raised an interest in liver tumor radiotherapy,with literature evolving to support its efficacy.These advances,particularly stereotactic body radiation therapy(SBRT),have been critical in improving local control or potential cure in liver lesions not amenable to first-line surgical resection or radiofrequency ablation.Active investigation of SBRT,particularly for hepatocellular carcinoma(HCC),has recently started,yielding promising local control rates.In addition,data suggest a possibility that SBRT can be an alternative option for HCC unfit for other local therapies.However,information on optimal treatment indications,doses,and methods remains limited.In HCC,significant differences in patient characteristics and treatment availability exist by country.In addition,the prognosis of HCC is greatly influenced by underlying liver dysfunction and treatment itself in addition to tumor stage.Since they are closely linked to treatment approach,it is important to understand these differences in interpreting outcomes from various reports.Further studies are required to validate and maximize the efficacy of SBRT by a large,multi-institutional setting.     

组织芯片检测肝肠钙粘连蛋白在肝癌组织中的表达及临床意义

目的研究肝肠钙粘连蛋白（LI—cadherin）在肝癌组织中的表达以及与肝癌的发生发展和临床病理特征之间的相关性。方法采用免疫组织化学sP法检测70例不同类型肝癌组织和5例正常肝组织标本中LI—cadherin的表达情况,并结合临床资料和相关病理参数进行统计分析。结果70例肝癌组织中LI—cadherin阳性表达39例,总阳性率为55．7％,5例正常肝组织中未见阳性表达;LI—cadherin的表达与年龄、性别、肿瘤分化程度以及有无远处转移无关（P〉0．05）,而与淋巴结转移及血管侵犯密切相关（P〈0．05）。结论LI—cadherin的表达与肝癌的发生、转移和浸润有关,LI—cadherin可能成为诊断肝癌发生、转移及临床分期的新生物学标志物,对于提高临床治疗效果具有指导意义。     

Hepatocellular carcinoma with portal vein tumor thrombosis: Improved treatment outcomes with external beam radiation therapy

The treatment of advanced hepatocellular carcinoma (HCC) associated with portal vein tumor thrombosis (PVTT) is very challenging because of HCC's grave prognosis. Despite many efforts to improve the treatment results, patient survival has been limited to several months. In this situation, radiotherapy has been considered as an alternative treatment modality because of the growth of knowledge about the radiotolerance of normal tissue and the advances of radiotherapy techniques such as three dimensional conformal radiotherapy, intensity modulated radiotherapy, stereotactic body radiotherapy and proton therapy. More restoration of the liver function and longer survival of the patients can be achieved by the better response after radiotherapy. However, considering the high risk of intrahepatic advanced tumor or extrahepatic dissemination by PVTT at disease presentation, a combination of radiation therapy and systemic agents will be desirable. Therefore, performing prospective randomized clinical trials is important to assess the benefits of radiotherapy and to develop combination treatment strategies.     

Proton therapy for hepatocellular carcinoma:Current knowledges and future perspectives

Hepatocellular carcinoma(HCC) is the second leading cause of cancer-related death, as few patients can be treated with currently available curative local modalities. In patients with HCC where curative modalities are not feasible, radiation therapy(RT) has emerged as an alternative or combination therapy. With the development of various technologies, RT has been increasingly used for the management of HCC. Among these advances, proton beam therapy(PBT) has several unique physical properties that give it a finite range in a distal direction, and thus no exit dose along the beam path. Therefore, PBT has dosimetric advantages compared with X-ray therapy for the treatment of HCC. Indeed, various reports in the literature have described the favorable clinical outcomes and improved safety of PBT for HCC patients compared with X-ray therapy. However, there are some technical issues regarding the use of PBT in HCC, including uncertainty of organ motion and inaccuracy during calculation of tissue density and beam range, all of which may reduce the robustness of a PBT treatment plan. In this review, we discuss the physical properties, current clinical data, technical issues, and future perspectives on PBT for the treatment of HCC.     

外科理念指导下的大肝癌放疗

近年来随着医疗技术水平的提高,肝癌的治疗疗效较前有所提高,但对于大肝癌的治疗仍是临床治疗难点。介绍了大肝癌的生物学特性,对大肝癌的手术治疗(包括肝切除术和肝移植术)、放射治疗的疗效进行了阐述。认为借鉴外科理念,放疗为不能手术的患者提供了一个新的选择。但如何量化肝功能储备的指标,如何限制健肝的体积及受照射剂量,联合其他局部治疗提高肿瘤控制率,仍是亟待解决的问题。