ObjectiveTo determine the risk factors for recurrence of hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). MethodsThe clinical data from seventysix consecutive HCC patients who underwent OLT were retrospectively analyzed. The patients were divided into nonrecurrence group (n=53) and recurrence group (n=23) based on recurrence, and the characteristics of tumor recurrence were analyzed. ResultsThe overall recurrence rate of tumor was 30.3% (23/76). By univariate analysis, gender (P=0.449), age (P=0.091), received preoperative therapy or not (P=0.958), tumor numbers (P=0.212), and HBV/HCV infection (P=0.220) were not closely related with tumor recurrence, while the integrality of tumor capsule (P=0.009), tumor stage (P=0.002), tumor diameter (Plt;0.001), vascular invasion (Plt;0.001), and AFP level before transplantation (P=0.044) were significantly related with tumor recurrence. Furthermore, the oneyear recurrence rate of tumor was higher in patients whose AFP level returned to normal within two months after transplantation (Plt;0.001) and tumor diameter was less than 5.0 cm (P=0.001). Multivariate analysis revealed that tumor diameter (P=0.001, OR=6.456, 95%CI: 2.356-17.680), vascular invasion (P=0.030, OR=10.653, 95%CI: 1.248-90.910), and AFP level before transplantation (P=0.017, OR=2.601, 95%CI: 2.196-5.658) were independent risk factors for tumor recurrence. ConclusionMore attentions shall be paid to these patients with tumor diameter gt;5.0 cm, vascular invasion, and AFP level before transplantation ≥400 μg/L, in particular AFP level is beyond normal within two months after transplantation, and antitumor therapy shall be given as soon as possible.
Objective To construct a mammalian vector encoding angiostatin kringle 5 (K5) under the control of αfetoprotein （AFP） enhancer and albumin promoter, and to observe the expression of angiostatin by introducting angiostatin gene into hepatocellular carcinoma cells through gene transfection. Methods Angiostatin cDNA was amplified from normal human eukaryotic cells by using RTPCR. Meanwhile, AFP enhancer and albumin promoter sequences were directed cloned and were inserted into vector pcDNA3.1. The recombinant vector of pcDNA3.1AFABangiostatin K5His was constructed, which contained the angiostatin K5 cDNA sequence that was under the control of the AFP enhancer and promoter. Angiostatin K5 cDNA was introduced into human AFP positive hepatocellular carcinoma cell lines with the transfected cultured cells that were mediated with Lipofectamine 2000. The expression of angiostatin K5 was analyzed by Western blot and the protein was dectected with antiHis antibody. Results The 500base pair of angiostatin K5 was in accordance with the expected sequence and the recombinant vector of pcDNA3.1AFABangiostatin K5His was also confirmed as the anticipated sequence. The expression of angiostatin K5 in AFP positive hepatocellular carcinoma cells was detected both by SDSPAGE and Western blot. Conclusion Efficient construction and expression of angiostatin K5 to AFP positive cells make it possible for antiangiogenesis therapy of human hepatocellular carcinomas, which may provide a promising approach.
【Abstract】Objective To explore the changes of expression of AFP mRNA in human hepatocellular carcinoma （HCC） tissues after oral Xeloda therapy.Methods Total RNA was extracted from HCC tissue samples collect after operation and nested reverse transcription polymerase chain reaction （RT-nested PCR） assay was performed to determine the expression of AFP mRNA in this study.Results The final product of AFP mRNA amplified by RT-PCR was 174 bp and by RT-nested PCR was 101 bp. The AFP mRNA is positive in 12 of 21 patients (positive rate 57.14%) amplified by RT-nested PCR assay in Xeloda treatment group which is much lower than control group: 18 of 20 patients (positive rate 90.00%),P＜0.05.The serum AFP value of Xeloda treatment group 〔(23.2±12.8) μg/L〕 is much lower than that of control group 〔(39.6±24.3) μg/L〕 four weeks after operation (P＜0.05). However, There was no difference between two groups in serum AFP value before operation.Conclusion Xeloda can effectively suppress the expression of AFP mRNA in human HCC tissues and lower it’s product serum AFP value.The clinical application of Xeloda in HCC patients deserve further study.
【Abstract】Objective To investigate whether liver resection for hepatocellular carcinoma (HCC) causes dissemination of liver tumor cells into blood circulation. Methods Fourteen patients with HCC, but without evidences of metastasis, were enrolled for the study. Blood samples of peripheral blood before skin incision and after abdominal wall suture, and of hepatic venous blood and portal venous blood after liver parenchyma dissection, were obtained. AFPmRNA was detected by reverse transcription polymerase chain reaction assays, the change of the level of its expression during operation was assessed by semi-quantitative analysis. Results The rate of its expression before and after operation in peripheral blood, and during operation in portal venous blood and in hepatic venous was 42.9%, 35.7%, 42.9% and 57.1% respectively. There were no differences between them. However, the level of its expression in hepatic venous blood was significantly higher than others (P＜0.05). Conclusion Liver resection for HCC induces releases of cells from the liver, probably including tumor cells, into blood circulation.
Objective To systematically evaluate AFP as the diagnostic standard for Chinese primary liver cancer (PLC). Methods A comprehensive electronic search and additional manual tracking were performed to retrieve relevant studies on AFP in diagnosis of Chinese PLC. All studies were divided into three groups according to the cutoff value of AFP: 20 or 25 ?g/L, 200 ?g/L, 400 ?g/L (Groups 1, 2, and 3, respectively). The data about the accuracy of the included studies were extracted for further heterogeneity studies; statistical pooling and SROC (summary receiver operating characteristics) were analyzed using MetaDisc 1.4 software. Results Twenty studies which were selected from 1,062 references met the inclusion criteria. Heterogeneity (except for threshold effect) was found within the three groups. A Meta-analysis was performed using the random effect model. Compared with the other two groups, the specificity of Group 3 (AFP 400 ?g/L) was the highest (0.977, 95%CI 0.967 to 0.985) and sensitivity was the lowest (0.422, 95%CI 0.403 to 0.441). The values of LR+ and dOR were lower than those of Group 2 (AFP 200?g/L) (17.691: 19.669; 32.820: 53.599, respectively). Area under curve (AUC) of SROC and Q index of Group 3 were also lower than those of Group 2 (0.6575: 0.832 3; 0.633 8: 0.782 2, respectively). Conclusion Four-hundred ?g/L of AFP as the diagnostic standard for PLC is not good enough, and we suggest that 200 ?g/L may be better than 400 ?g/L for PLC diagnosis.
Objective To evaluate the accuracy and quality of diagnostic test of Electrochemiluminescence immunoassay (ECLIA) in detecting A-fetal protein (AFP) for the diagnosis of liver cancer in Chinese patients. Methods We searched Chinese Biological Medicine Database (CBM, 1978 to 2005) and China National Knowledge Infrastructure (CNKI, 1994 to 2005). Diagnostic tests of ECLIA in detecting AFP for the diagnosis of liver cancer were included. Data were extracted, and the quality of included studies was evaluated according to the six criteria of diagnostic tests. Results Forty-eight studies were identified, but only 6 were included and none mentioned the indices about the accuracy. Conclusion The number of studies of ECLIA in detecting AFP for the diagnosis of liver caner is few and the quality is poor. We cannot draw the conclusion that ECLIA is better for sensitivity and specificity.
目的 通过检测肝病患者血清甲胎蛋白异质体（AFP-L3）浓度和AFP-L3/血清甲胎蛋白（AFP）比值，分析探讨并联运用两指标在肝细胞癌（HCC）诊断中的价值。 方法 选取2011年3月－11月137例的住院患者血清标本，AFP检测均为阳性。依据病理学诊断，将137例患者分为两组，HCC组92例，良性肝病组45例，后者包括肝硬化结节37例、慢性活动性肝炎8例。采用酶联免疫吸附试验（ELISA）检测所有患者血清AFP-L3浓度；同时运用微量吸附柱法分离血清中的AFP-L3，采用电化学发光法检测分离后的AFP-L3和血清中总AFP浓度，计算AFP-L3/AFP比值。计算采用AFP-L3浓度与AFP-L3/AFP比值以及AFP-L3浓度与AFP-L3/AFP比值两指标并联诊断HCC的灵敏度、特异度、Youden指数等统计学指标，探讨其在原发性肝癌诊断中的价值。 结果 ① HCC组 AFP-L3浓度（109.04 ± 62.51）ng/mL，明显高于良性肝病组（25.96 ± 49.43）ng/mL，差异有统计学意义（t=8.28，P＜0.001）。HCC组血清AFP-L3/AFP比值（17.35 ± 14.48%）高于良性肝病组（5.617 ± 6.38%）, 差异有统计学意义（t=6.545，P＜0.0001）。② 以血清AFP-L3浓度＞38.0 ng/mL作为临界值诊断原发性肝癌的灵敏度为83.69%，特异度为88.88%，以AFP-L3/AFP比值＞10%作为临界值诊断原发性肝癌的灵敏度为83.69%，特异度为95.55%。③ 并联应用血清AFP-L3浓度＞38.0 ng/mL、AFP-L3/AFP＞比值7.5%诊断HCC的灵敏度为97.83%，特异度为84.44%。 结论 并联应运AFP-L3浓度与AFP-L3/AFP比值诊断HCC较应用单一指标诊断特异度稍有下降，但明显提高了诊断的灵敏度，更有利于HCC的早期诊断。
目的 提高睾丸内胚窦瘤的诊治水平。 方法 对2010年8月和2011年9月分别收治的2例睾丸内胚窦瘤诊治资料进行分析并结合文献复习。 结果 2例均行患侧睾丸肿瘤根治性切除术，术后分别随访3个月和1年，无局部复发及处转移。 结论 甲胎蛋白结合影像学检查可提高睾丸内胚窦瘤的诊断率；根治术结合放射治疗、化学治疗能提高治愈率；甲胎蛋白可作为观察疗效的指标。
目的 探讨酶联免疫吸附试验(ELISA)检测血清甲胎蛋白异质体(AFP-L3)含量对原发性肝癌（PLC）的诊断价值。 方法 选择2011年3月－11月门诊或住院的137例患者临床检测甲胎蛋白(AFP)为阳性的肝病患者血清，应用上海逸峰生物科技有限公司提供的ELISA法AFP-L3检测试剂盒检测AFP-L3浓度，137例中男98例，女39例，年龄28～77岁。其中PLC 92例，良性肝病45例，后者包括肝硬化37例、慢性肝炎8例。分析PLC组与良性肝病组AFP-L3浓度差异，运用受试者工作特征曲线(ROC)分析AFP-L3含量在PLC鉴别诊断中的价值。 结果 PLC组AFP-L3浓度[（109.04 ± 62.51）ng/mL]明显高于良性肝病组[（25.96 ± 49.43）ng/mL，两组差异有统计学意义（t=8.28 ，P＜0.001）。ROC分析结果显示，曲线下面积为0.819，以AFP-L3浓度37.89 ng/mL为临界值，分析92例PLC患者与45例良性肝病患者AFP-L3浓度异常的灵敏度为83.69%，特异度为88.88%，阳性预测值为93.90%（77/82），阴性预测值为72.72%（40/55），诊断准确度为85.40%。 结论 应用简便快速的ELISA法检测AFP-L3浓度在PLC与良性肝病鉴别诊断中具有较高的临床价值，便于临床推广。
目的:探讨甲胎蛋白(AFP)含量与慢加急性肝衰竭预后的关系,进一步了解肝衰竭患者AFP含量的变化。方法:将回顾分析的65 例慢加急性肝衰竭患者根据最后治疗结果分为存活组与死亡组,分析对比两组在不同时间AFP含量的差异,同时观察AFP含量与总胆红素(TBil),凝血酶原活动度(PTA)的关系。结果:65 例患者中AFP含量高于正常者53 例(81.54%),存活组不同时期的AFP含量平均值均高于死亡组,有显著差别(Plt;0.01)。AFP含量升高(≥300 IU/mL)主要分布在血清总胆红素lt;510 μmoL/ mL,凝血酶原活动度gt;30 %患者中,随AFP含量升高,病死率下降。结论:慢加急性肝衰竭患者血清AFP含量升高反应了肝细胞再生活跃,提示预后良好。