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.
ObjectivesTo systematically review serum a-L Fucose Gan Enzyme (AFU) combined with serum Alpha-Fetoprotein (AFP) in the diagnosis of primary hepatic carcinoma (PHC). MethodsWe comprehensively searched databases including PubMed, The Cochrane Library (Issue 2, 2013), WanFang Data, VIP, CBM, CNKI, EMbase, and Medalink for relevant studies on AFU combined with AFP in the diagnosis of PHC from inception to July 2013; meanwhile, manual search for the relevant Chinese journals were also performed. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using Meta-DiSc 1.4 software. ResultsA total of 20 studies involving 1 350 cases and 2 079 controls were included. The results of meta-analysis showed that, pooled sensitivity, specificity, positive likelihood radio, negative likelihood radio, diagnostic odds ratio, the area under SROC curve and Q index were:a) detection of AFU alone:0.76 (0.74, 0.78), 0.83 (0.82, 0.85), 7.09 (4.34, 11.58), 0.29 (0.23, 0.37), 26.88 (15.04, 48.06), 0.872 6 and 0.803, respectively; b) detection of AFP alone:0.69 (0.67, 0.72), 0.88 (0.86, 0.89), 7.85 (5.35, 11.50), 0.35 (0.30, 0.42), 25.62 (16.35, 40.15), 0.805 4 and 0.740 6, respectively; and c) combined detection of AFU and AFP:0.85 (0.83, 0.87), 0.86 (0.85, 0.88), 7.16 (5.15, 9.96), 0.15 (0.10, 0.23), 54.07 (29.85, 97.95), 0.940 8 and 0.878 5, respectively. ConclusionThe combination detection of AFU and AFP has good efficacy in the diagnosis of PHC.
Objective To explore the expression of CD34 and polyclone carcinoembryonic antigen (pCEA) of positive and negative alpha fetoprotein (AFP) detected by puncture biopsy in human hepatocellular carcinoma (HCC) and the significance of pathological diagnosis. Methods Fifty-four HCC tissue specimens from 2013 to 2015 were collected from tumor biopsy samples which confirmed by pathology in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture. The tissue samples were divided into positive AFP group (n=33) and negative AFP group (n=21) according to the detection results of serology and immunohistochemistry analysis of AFP. Expressions of CD34 and pCEA in the fifty-four HCC specimens were detected by immunohistochemistry. Results The positvie expression rate of pCEA in the positive AFP group was 69.7%, which was significantly higher than that in the negative AFP group (38.1%) (P<0. 05). However, the difference in positive expression rate of CD34 between the positive and negative AFP groups (90.91% and 85.71%, respectively) was not significant (P>0.05). Conclusion The associated detection of AFP, pCEA and CD34 in HCC tissues might contribute to the pathological and differential diagnosis of human hepatocellular carcinoma in puncture biopsies.
ObjectiveTo evaluate the relationship between the expression of alpha fetoprotein (AFP) and chemoresistance in hepatocellular carcinoma.MethodsHepatocellular carcinoma was screened from liver tumor tissue samples, which was obtained by puncture before transcatheter arterial chemoembolization (TACE). Immuno-histochemical staining was used to detect the expression of AFP in HCC tissues and the effect of AFP expression in HCC on the effect of chemotherapy was analyzed.ResultsA total of 62 patients met the inclusion criteria, of which 36 were in the chemotherapy resistant group and 26 in the chemotherapy sensitive group. There were 42 patients with positive expression of AFP in tumor tissues (including 29 patients with chemoresistance) and 20 patients with negative expression of AFP in tumor tissues (including 7 patients with chemoresistance). There were no significant difference between the two groups in sex, age, tumor differentiation, Child-Pugh classification of liver function, tumor size, tumor site and hepatitis (P>0.05). In elevated serum AFP level, tumor single, and with portal vein tumor thrombus (PVTT), the proportion of patients in the chemosensitivity group were significantly lower than that in the chemosensitivity group (P<0.05). The results of logistic multivariate regression analysis showed that positive expression of AFP ［OR=0.280, 95%CI (0.092, 0.950), P=0.045］ and PVTT ［OR=0.026, 95%CI (0.004, 0.322), P=0.005］ were independent risk factors for chemotherapeutic resistance in hepatocellular carcinoma.ConclusionAFP positive expression in liver tumor tissues and PVTT are useful indicators of resistance to chemotherapy.