Pyruvate kinase M2 is a novel diagnostic marker and predicts tumor progression in human biliary tract cancer

BACKGROUND:

The early diagnosis of biliary tract cancer (BTC) remains challenging, and there are few effective therapies. This study investigated whether the M2 isotype of pyruvate kinase (M2‐PK), which serves as the key regulator of cellular energy metabolism in proliferating cells, could play a role in the diagnosis and therapy of BTC.

METHODS:

Plasma and bile M2‐PK concentrations were measured by enzyme‐linked immunosorbent assay in 88 patients with BTC, 79 with benign biliary diseases, and 17 healthy controls. M2‐PK expression was assayed in a BTC tissue array by immunohistochemistry. The role of M2‐PK in tumor growth, invasion, and angiogenesis was evaluated in BTC cell lines by retrovirus‐mediated M2‐PK transfection and short hairpin RNA silencing techniques.

RESULTS:

Sensitivity (90.3%) and specificity (84.3%) of bile M2‐PK for malignancy were significantly higher than those for plasma M2‐PK and serum carbohydrate antigen 19‐9. M2‐PK expression was specific for cancer cells and correlated with microvessel density. M2‐PK positivity was a significant independent prognostic factor by multivariable analysis. Transfection of M2‐PK in a negatively expressed cell line (HuCCT‐1 cells) increased cell invasion, whereas silencing in an M2‐PK–positive cell line (TFK cells) decreased tumor nodule formation and cellular invasion. A significant increase in endothelial tube formation was noted when supernatants from M2‐PK–transfected cells were added to an in vitro angiogenesis assay, whereas supernatants from silenced cells negated endothelial tube formation.

CONCLUSIONS:

Bile M2‐PK is a novel tumor marker for BTC and correlates with tumor aggressiveness and poor outcome. Short hairpin RNA–mediated inhibition of M2‐PK indicates the potential of M2‐PK as a therapeutic target. Cancer 2013. © 2012 American Cancer Society.     

Intrahepatic Cholangiocarcinoma Mimicking Hepatic Inflammatory Pseudotumor

A 50-year-old male with hepatitis B was referred for a small intrahepatic nodule. Magnetic resonance images raised strong suspicion of a benign lesion, such as an inflammatory pseudotumor, while the other radiological studies were equivocal. Furthermore, the high-intensity image on diffusion magnified-weighted imaging with a low B value strongly suggested a benign tumor. In spite of the absence of typical clinical or radiological findings, needle biopsy revealed an intrahepatic cholangiocarcinoma (ICC). The diagnosis of peripheral ICC rich in fibrous tissue seems to require needle biopsy for pathological examination with immunohistochemical staining because it frequently mimics other diseases, including benign tumors.     

胆管癌患者血清IL—6检测意义

目的：探讨血清白细胞介素－6（interleukin,IL-6）在胆管癌疾病中临床意义。方法：选择30例胆管良性疾病患者，25例胆管癌患者，20例健康者。采用ELISA双抗体夹心法测血清IL－6的水平变化。结果：25例胆管癌患者血清中IL－6水平明显高于胆管良性疾病及健康者（P＜0.05），胆管癌手术后血清IL－6水平明显低于手术前，有显著差异（P＜0.05）。结论：胆管癌患者血清IL－6水平明显增高，检测血清IL－6可做为诊断胆管癌重要指标。     

胆道镜联合超声内镜在肝门胆管癌诊治中的应用

目的探讨肝门胆管癌的早期诊断方法。方法回顾性分析24例患者在术中及术后行胆道镜联合超声内镜检查诊断为胆管癌的临床资料。结果24例均经相应手术,无手术死亡病例。结论肝门部胆管癌早期诊断困难,胆道镜联合超内镜可提高诊断率及手术成功率。     

CT在肝内胆管结石诊断中的应用

目的探讨肝内胆管结石的CT表现及诊断价值。方法对35例肝内胆管结石CT征象进行分析。结果CT诊断肝内胆管结石33例,准确率达95%;CT可准确显示和诊断其合并症。结论CT是肝内胆管结石有效的诊断手段,其诊断准确性特别是对并发症的诊断优于B超。     

Liver transplantation for primary and metastatic liver cancers

Liver transplantation for hepatic malignancies has emerged as a well‐documented and proven treatment modality. However, early unsatisfactory results emphasized that only a highly selected patient population would benefit from transplantation. Currently, 15% of all liver transplants performed are for hepatocellular carcinoma (HCC). There is no controversy about the fact that liver transplantation for HCC in the adult population yields good results for patients whose tumour masses do not exceed the Milan criteria. It remains to be determined whether patients with more extensive tumours can be reliably selected to benefit from the procedure. In patients with small HCC at an early stage and preserved liver function, liver resection provides an alternative to transplant. Liver resection may offer similar survival results to orthotopic liver transplantation (OLT) in the short term, and does not carry the long‐term effects of immunosuppression; however, long‐term and disease‐free survival favours liver transplantation. Very promising results have been obtained for cholangiocarcinoma treated by aggressive combination therapies, including chemo‐ and radiotherapy followed by OLT. Survival rate in these selected patients can approach that of patients with cholestatic liver disease, and the role of transplantation now requires re‐evaluation. Similarly, hepatoblastoma is an excellent indication in paediatric patients with unresectable or recurrent tumours. Epithelioid hemangioendothelioma is also an appropriate indication for liver transplantation, even in the presence of extrahepatic metastases, unlike angiosarcoma which is associated with a very poor survival and considered as a contraindication. And finally for metastatic liver disease from neuroendocrine tumours, liver transplantation can result in long‐term survival and even cure in well selected patients. Conversely, the value of transplantation for colorectal liver metastases (currently a contraindication) requires further evaluation by well‐designed trials.     

老年人肝内胆管细胞癌临床特征

目的探讨老年人肝内胆管细胞癌(ICC)的临床特征,为诊断和治疗提供临床思路。方法回顾性分析2001-2005年3月收治的25例老年患者(≥60岁)和40例非老年患者(<60岁)的临床资料并进行两组间比较。结果①老年组乙肝史和血清学HBV阳性率均低于非老年组(12%vs37.5%,40%vs67.5%,P<0.05),老年组血清总胆红素(TB)[(11.70±3.271)μmol/Lvs(15.53±6.142)μmol/L]和结合胆红素(CB)[(3.957±3.957)μmol/Lvs[5.792±3.046)μmol/L]低于非老年组(P<0.01)。两组间临床症状、血清学肿瘤标志物水平、手术切除率、淋巴结和脉管内转移率均无显著差别。②CT提示淋巴结肿大和病理提示脉管内癌栓是肿瘤转移的危险因素,其中CT提示淋巴结肿大是肿瘤转移的独立危险因素。③9例患者手术后复发,乙肝史是肿瘤复发的独立危险因素之一。结论老年组慢性乙肝患病率和血清学HBV阳性率均低于非老年组,血清TB和CB水平低于非老年组。年龄不是手术禁忌症。     

肝门部胆管癌术前减黄临床价值

目的探讨术前减黄对肝门部胆管癌手术切除病人的影响。方法回顾中山大学附属第一医院1999年1月至2005年12月58例血清总胆红素(TB)>85μmol/L的肝门部胆管癌手术切除病人临床资料,分析并发症的发生情况以及减黄和其他因素对术后并发症、病死率的影响。结果术前减黄31例(53.4%,31/58),平均减黄9d,减黄组术前的TB下降为(214±125)μmol/L,与减黄前的(292±103)μmol/L及未减黄组术前的(382±174)μmol/L相比差异有显著性意义。术前减黄可降低天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、丙氨酸转氨酶(ALP)、直接胆红素(DB)水平。术后并发症总发生率为55.2%(32/58);减黄组为58.1%(18/31),未减黄组为51.9%(14/27),两组之间差异无显著性意义。单个并发症总发生率两组之间差异亦无显著性意义。影响术后病死率的危险因素为肝切除,影响术后肾功能不全的危险因素为TB>340μmol/L。结论术前减黄可以有效降低胆红素水平及改善肝门部胆管癌手术切除病人术前的肝功能;肝门部胆管癌切除手术的风险性较高;术前胆红素过高易引发术后肾功能不全;术前是否减黄与术后并发症发生率不相关。     

肝内胆管细胞癌外科手术治疗的现状与进展

肝内胆管细胞癌(ICC)是原发于肝脏的恶性肿瘤,其恶性程度高、远期预后差。根治性手术切除是目前治疗ICC的唯一有效手段。而近年来,随着对ICC生物学行为和临床特点认识的不断深入,其临床分期、手术指征、手术方式、淋巴结清扫等外科治疗策略也在发生着转变。本文结合近年来临床最新研究进展,针对ICC的外科手术治疗的现状进行综述。     

腹腔镜胆总管探查取石术治疗复杂性肝内胆管结石的效果及对血清炎症因子的影响

目的 分析腹腔镜胆总管探查取石术治疗复杂性肝内胆管结石的临床价值。方法 选取2018年2月－2020年2月该院复杂性肝内胆管结石患者106例，随机分为常规组（n = 53）和治疗组（n = 53），治疗组接受腹腔镜胆总管探查取石术，常规组接受传统开腹胆总管探查取石术。比较两组患者治疗后的手术效果、炎症因子水平、并发症发生率、结石复发率和生活质量评分。结果 治疗组肛门恢复排气时间、住院时间和手术时间均明显短于常规组，术中出血量明显少于常规组（P < 0.05）。术后3 d，C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-1（IL-1）水平明显低于常规组（P < 0.05）。治疗组并发症发生率和结石复发率明显低于常规组（P < 0.05），生活质量评分明显高于常规组（P < 0.05）。结论 采用腹腔镜胆总管探查取石术治疗肝内胆管结石，不仅可以提高治疗效果，降低结石复发率，还抑制炎性因子释放，促进机体恢复。