CEA、AFP、CA199、FERR联合检测对肝癌的诊断意义

目的 探讨血清癌胚抗原(CEA)、甲胎蛋白(AFP)、糖类抗原199(CA199)和铁蛋白(FERRitin,FERR)联合检测在肝癌(LC)中的诊断意义。方法 选取2016-01～12在延安大学附属医院就诊的110例原发性肝癌患者(PHC),41例转移性肝癌患者(MHC),124例肝良性病变患者(良性组),及同期50例体检者(对照组),采用电化学发光技术检测PHC、MHC、良性组及对照组血清中的CEA、AFP、CA199、FERR的水平,并进行4组间单项及联合检测阳性率的比较。结果 MHC血清中CEA、CA199的水平最高,差异具有统计学意义(P＜0.05);PHC组血清中AFP的水平最高,差异具有统计学意义(P＜0.05);四项联合检测的阳性率在PHC与MHC差异无统计学意义(P＞0.05);PHC与MHC四项联合测定阳性率均高于良性组及对照组,差异具有统计学意义(P＜0.01);良性组四项联合测定的阳性率高于对照组,差异具有统计学意义(P＜0.01)。结论 CEA、CA199对MHC诊断具有重要意义,AFP对PHC诊断具有重要意义,CEA、AFP、CA199、FERR四项联合检测可提高肝癌诊断的阳性率,有利于肝癌的早期诊断和治疗。     

Predictive and prognostic value of serum AFP level and its dynamic changes in advanced gastric cancer patients with elevated serum AFP

AIM To investigate predictive and prognostic value of serum alpha-fetoprotein(AFP) level and its dynamic changes in patients with advanced gastric cancer with elevated serum AFP(AFPAGC).METHODS One hundred and five patients with AFPAGC were enrolled in the study, and all of them underwent at least one cycle of systemic chemotherapy at our institute and had serum AFP ≥ 20 ng/m L at diagnosis or recurrence. Clinicopathologic features, serum AFP level at diagnosis and changes during treatment, first-line chemotherapy regimens, efficacy and toxicity, and survival information were collected. A Person's χ~2 or Fisher's exact test was used to measure the differences between variables. Survival prognostic factors were investigated using the Kaplan-Meier method and Cox regression.RESULTS Median serum AFP level was 161.7 ng/m L(range, 22.9-2557110 ng/m L). Objective response rates(ORR) was significantly lower in the AFP ≥ 160 ng/m L group than in the AFP 160 ng/m L group(30.4% vs 68.3%, P 0.001). ORR to doublet regimens was significantly lower in the AFP ≥ 160 ng/m L group, whereas ORR to triplet regimens was similar between the two groups. Liver metastasis rate was significantly higher in the AFP ≥ 160 ng/m L group than in the AFP 160 ng/m L(69.8% vs 50.0%, P 0.001). Overall survival(OS) in the two cohorts did not show any significant difference(P = 0.712). Dynamic changes of AFP were consistent with response to chemotherapy, and median OS of patients with a serum AFP decline ≥ 50% and those with a serum AFP decline 50% was 17.5 m and 10.0 m, respectively(P = 0.003). Hepatic(P = 0.005), peritoneal(P 0.001), non-regional lymph node metastasis(P 0.001), and portal vein tumor thrombus(PVTT)(P = 0.042) were identified as independent prognostic factors for AFPAGC. CONCLUSION Real-time examination of AFP has great predictive and prognostic value for managing AFPAGC. For those with markedly elevated AFP, triplet regimens may be a better choice.     

术前血清前白蛋白水平与甲胎蛋白阴性肝细胞癌患者预后的关系

目的 探讨术前血清前白蛋白（prealbumin,PA）对甲胎蛋白阴性的肝细胞癌（alpha-fetoprotein-negative hepatocellular carcinoma,AFP-NHCC）患者预后的影响。方法 回顾性分析2014年1月至2015年12月于广西医科大学附属肿瘤医院接受肝切除术的118例AFP-NHCC患者的临床资料。根据PA临界值将患者分为低PA组（<170 mg/L）和高PA组（≥170 mg/L）,采用Cox回归分析术前血清PA水平与AFP-NHCC患者预后的关系。结果 术前血清PA水平与肿瘤直径、大血管侵犯、Child-Pugh分级和BCLC分期有关（P<0.05）。Kaplan-Meier 生存分析结果显示,低PA组患者的中位生存时间较高PA组短（24.5 个月vs 36.0个月,χ²=11.689,P=0.001）。Cox 回归分析显示,低PA组的死亡风险大于高PA组（HR=2.779, 95%CI：1.406~5.492,P=0.003）,控制潜在混杂因素后这种关系依然存在。结论 术前血清低前白蛋白水平与 AFP-NHCC患者不良预后有关,可作为评估预后的指标。     

HBV 相关慢加急（亚急）性肝衰竭患者血清AFP、CA199临床意义的研究

目的 探究发病1周内血清甲胎蛋白（AFP）及CA199水平与HBV相关慢加急（亚急）性肝衰竭（HBV-ACLF）患者病情及预后的关系。方法 回顾性分析2013年1月~2017年12月我院收治的62例HBV 相关慢加急（亚急）性肝衰竭患者的临床资料,记录患者入院1周内AFP、CA199、TBiL、PTA及ALB临床数据,比较AFP及CA199水平阳性与阴性对应肝功情况,进一步分别将AFP水平划分为＜100 ng/ml、100~200 ng/ml、＞200 ng/ml三个水平梯度及CA199水平划分为＜120 U/ml、120~200 U/ml、＞200 U/ml三个水平梯度,比较对应肝生化指标、存活及死亡率情况。分析AFP及CA199水平与终末期肝病模型评分（Meld评分）相关性,将Meld评分划分为＜20分、20~24分、25~29分、≥30分等四个梯度,比较AFP及CA199水平,结合存活组与死亡组AFP及CA199水平,探究AFP及CA199水平对患者预后的预测价值。结果 ①CA199水平阳性患者TBiL水平高于阴性患者、PTA水平低于阴性患者,差异有统计学意义（P＜0.05）;AFP水平阳性与阴性患者肝生化指标比较,差异无统计意义（P＞0.05）;②AFP＞200 ng/ml时TBiL及PTA水平最高,AFP＜100 ng/ml时TBiL及PTA水平最低,AFP不同梯度组下各肝生化指标比较,差异均无统计学意义（P＞0.05）;CA199＞200 U/ml时TBiL水平最高,PTA水平最低,TBiL水平随CA199梯度增加而升高,PTA水平随之下降,CA199不同梯度下TBiL及PTA水平比较,差异均有统计学差异（P＜0.05）;③在AFP＜100 ng/ml梯度组患者死亡率最高,达到28.57%;CA199＞200 U/ml梯度组死亡率最高,达到33.33%;④Meld评分≥30分,死亡率最高,AFP水平最低,AFP水平在不同Meld评分梯度下比较,差异无统计学意义（P＞0.05）;⑤Meld评分＜20分时,死亡率最低,CA199水平最低,Meld评分在20~29分时CA199水平最高,CA199水平在不同Meld评分梯度下比较,差异有统计学意义（P＜0.05）;⑥AFP及CA199水平在存活组与死亡组之间比较,差异无统计学意义（P＞0.05）。结论 ①在一定程度内AFP随着肝损害加重而升高,当病情超过一定程度后,AFP呈现下降趋势,预后较差;一定范围内AFP水平升高,提示预后良好;②CA199水平与肝损害程度相一致,CA199水平越高,肝损害程度越重,当病情严重时CA199呈现下降趋势,预后较差;③在HBV-ACLF中联合检测AFP及CA199升高水平对于评估病情及预后有一定参考意义。     

BZW2和IVD在肝癌组织中的表达及其对肝癌肝移植受者预后的影响

目的 探讨碱性亮氨酸拉链和W2结构域2(BZW2)及异戊酰辅酶A脱氢酶(IVD)在肝细胞癌(肝癌)中的表达及其对肝移植受者预后的影响.方法 回顾性分析87例肝癌肝移植受者的病理标本及临床资料,分析肝癌肝移植受者术后肿瘤复发转移情况.采用免疫组织化学染色检测BZW2和IVD的表达情况,分析BZW2和IVD与肝癌临床病理参...     

Autoantibodies to tumor-associated antigens combined with abnormal alpha-fetoprotein enhance immunodiagnosis of hepatocellular carcinoma

The identification and characterization of tumor-associated antigens (TAAs) and their use in antigen mini-arrays for cancer immunodiagnosis has been of interest recently as an approach to cancer detection. In this study, autoantibodies in sera from a patient with HCC were used as probes to immunoscreen a HepG2 cDNA expression library for the identification of TAAs involved in malignant liver transformation. Recombinant proteins from two genes identified in this manner, Sui1 and RalA were expressed, purified and used as antigens in immunoassays to detect the presence of antibodies in sera from 77 patients with HCC, 30 with chronic hepatitis (CH), 30 with liver cirrhosis (LC) and 82 normal human sera (NHS). The prevalence of antibody to Sui1 and RalA in HCC were 11.7% (9/77) and 19.5% (15/77), respectively, which were significantly higher than prevalence in liver cirrhosis (3.3% and 3.3%), chronic hepatitis (0% and 0%) and normal human sera (0% and 0%). When Sui1 and RalA were added to a panel of eight other TAAs used in a previous study, the final cumulative prevalence of anti-TAA antibodies in HCC to the 10 TAA array was raised to 66.2% (51/77). The specificity for HCC compared with LC, CH and NHS, was 66.7%, 80.0%, and 87.8%, respectively. When anti-TAA was added to abnormal serum AFP as combined diagnostic markers, it raised the diagnostic sensitivity from 66.2% to 88.7%. AFP and anti-TAA were independent markers and the simultaneous use of these two markers significantly resulted in the increased sensitivity of HCC detection.     

Brief Report: A Second Primary Endodermal Sinus Tumor 9 Years after Initial Diagnosis

Background

Ovarian yolk sac tumors (YSTs) are rare malignant germ cell tumors known to present unilaterally, allowing for fertility-sparing surgical treatment with adjuvant chemotherapy. The few published cases of bilateral ovarian involvement were at the time of original diagnosis in patients with widely metastatic disease. We present, to our knowledge, the first case of bilateral ovarian YSTs, diagnosed several years apart, and discuss the implications on recurrence and tumor marker surveillance for these tumors.

Hepatoid adenocarcinoma of the stomach – proper identification and treatment remain a challenge

Objective The term hepatoid adenocarcinoma (HAC) of the stomach was introduced three decades ago with the observation of high serum α-fetoprotein (AFP) levels in some gastric adenocarcinoma patients. This very rare gastric cancer patient subgroup is likely frequently misdiagnosed. Material Two patients who were recently diagnosed with HAC of the stomach at our institution are presented. We also performed a structured literature search and reviewed pertinent articles to provide knowledge to improve the proper identification, diagnosis and management of patients with gastric HAC. Results HAC is a rare subgroup of gastric carcinoma with poor prognosis. Clinical management of this population may be challenging. The scientific literature is largely based on very small patient series or case reports, and the evidence for proper decision making and management is considered weak. Conclusion All physicians involved in the diagnosis and treatment of patients with gastric cancer should pay attention to this rare subgroup to improve identification.     

Hepatocellular carcinoma screening and surveillance in 2293 chronic hepatitis B patients in an endemic area

AIM To determine the role of screening and surveillance of hepatocellular carcinoma(HCC) in treatment-na?ve chronic hepatitis B(CHB) patients. METHODS We recruited 2293 CHB patients(both males and females; aged 20-65 years). All patients were screened and underwent surveillance using abdominal ultrasonography(AUS) and serum alpha-fetoprotein(AFP) assay every 6 mo. The diagnosis,staging and treatment of HCC followed the American Association for the Study of Liver Diseases practice guidelines and the Barcelona Clinic Liver Cancer guidelines. The exclusion criteria included: decompensated cirrhosis; a history of any cancer in the last 5 years; previous antiviral treatment for CHB; concurrent infection with hepatitis C virus or human immunodeficiency virus; a Karnofsky Performance Status score 60%; or any medical condition preventing eligibility to complete the protocol. The prevalence and incidence rates of HCC were determined; survival rates were calculated at 3-year post HCC diagnosis. The sensitivity and specificity were calculated on a per-patient basis.RESULTS Among 2293 treatment-na?ve CHB patients,seven cases had HCC at initial screening,giving a prevalence rate of 305 per 100000 persons; 3.3% were diagnosed with liver cirrhosis,all of which were Child-Pugh class A. With a median follow-up time of 42(range,3-48) mo,10 additional cases were diagnosed with HCC,resulting in an incidence rate of 143 per 100000 persons per year. This burden was as high as that reported in other studies from East Asian countries. All HCC patients were aged ≥ 40 years. Most were at an early stage(Stage 0,A or B); 14/17 cases were successfully treated with surgical resection or radiofrequency ablation,with a high 3-year survival rate of 90%. Hemangioma was the most common focal liver lesion in CHB patients detected by AUS; the main causes of AFP elevation at the initial screening were cirrhosis,increased alanine aminotransferase level and HCC. AUS detected 16/17 HCC cases whereas AFP levels ≥ 20 mg/L at diagnosis were observed in only 7/17 patients,most with a tumor size 5 cm. For HCC screening and surveillance,AUS had a sensitivity and specificity of 94% and 82%,respectively,whereas the sensitivity and specificity of AFP at a cut-off value of ≥ 20 mg/L were 41% and 98%,respectively. Combined use of AUS and AFP assay did not improve effectiveness. CONCLUSION Implementation of active screening and surveillance using AUS to detect early-stage HCC in na?ve CHB patients aged ≥ 40 years in an endemic area is of benefit.