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 discuss the clinical manifestations, diagnosis, and treatment of hepatoid adenocarcinoma of the stomach. Methods By summarizing the multi-disciplinary team results of 1 patient with hepatoid adenocarcinoma of the stomach, who underwent surgery in West China Hospital in October 2017, as well as reviewing the related literatures, to explore the clinicopathological features of hepatoid adenocarcinoma of the stomach. Results The clinical features of hepatoid adenocarcinoma of the stomach were often accompanied by early liver metastasis and alpha fetoprotein (AFP) significantly increased, which were easily misdiagnosed as primary hepatocellular carcinoma. The histopathological features of hepatoid adenocarcinoma of the stomach were characterized by two structures: hepatocellular carcinoma and adenocarcinoma. Conclusion Hepatoid adenocarcinoma of the stomach is a special type of gastric adenocarcinoma, and radical operation is the main treatment, but the prognosis of it is poor.
Objective To clarify relationship between signal heterogeneity on hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI and prognosis of hepatocellular carcinoma (HCC). Methods From January 2014 to January 2017 in the First Affiliated Hospital of Chongqing Medical University, a total of 77 patients with the pathologically proved HCC underwent Gd-EOB-DTPA-enhanced MRI prior to surgery were included in this study. On the basis of the signal heterogeneity in the hepatobiliary phase, the included patients were designed to homogeneous hypointensity group and heterogeneous hyperintensity group. The disease-free survival time were compared between the 2 groups and it’s influencing factors were analyzed. Results Seventy-seven patients with HCC were included, including 45 cases of homogeneous hypointensity and 32 cases of heterogeneous hyperintensity. There were no significant differences in the age, gender, etiology, liver function, alpha-fetoprotein, differentiated degree, Child-Pugh grade, lesion diameter, lesion border, and number of lesions between the 2 groups (P>0.05). However, the HCC patients with heterogeneous hyperintensity had a later BCLC staging (P=0.001). The disease-free survival time of the patients with homogeneous hypointensity and heterogeneous hyperintensity was (17.0±9.8) months and (12.4±10.4)months, respectively. The Kaplan-Meier survival curve showed that the disease-free survival time in the patients with homogeneous hypointensity was significantly better than that in the patients with heterogeneous hyperintensity (P=0.020). The results of univariate analysis showed that the other confounding factors had no effect on the disease-free survival time of patients with hepatocellular carcinoma (P>0.05) except for the signal of hepatobiliary phase (P<0.05). Furthermore, the hepatobiliary phase signal, BCLC stage, and degree of differentiation, which might be clinically considered as potentially influencing for the prognosis of patients with HCC, were included in the Cox multivariate proportional hazard regression model and found that the heterogeneous hyperintensity was still the risk factor of the disease-free survival rate in patients with HCC (P=0.047). Conclusion Signal heterogeneity on hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is related to prognosis of patients with HCC, heterogeneous hyperintensity may indicate a lower disease-free survival rate.
ObjectiveTo find out the risk factors affecting the prognoses and microvascular invasion (MVI) of patients with China Liver Cancer Staging-stageⅠ a (CNLC Ⅰ a) hepatocellular carcinoma (HCC). MethodsBased on the established inclusion and exclusion criteria, the clinicopathologic information and follow-up data of patients with CNLC Ⅰ a HCC were retrospectively collected, who underwent radical resection in the West China Hospital of Sichuan University from Jan. 2012 to Dec. 2016. The Cox proportional hazards regression was utilized to analyze the risk factors affecting the prognosis of patients with CNLC Ⅰ a HCC, and the non-conditional logistic regression was utilized to analyze the preoperative clinical indicators associating with MVI. ResultsA total of 300 patients with CNLC Ⅰ a HCC were included in this study, among which 51 (17.0%) cases accompanied with MVI. The follow-up period ranged from 2 to 104 months (median 39 months), with a recurrence time ranging from 2 to 104 months (median 52 months), and an overall survival time ranging from 3 to 104 months (median 98 months). During the follow-up period, postoperative recurrence occurred in 145 (48.3%) cases. The Cox proportional hazards regression analysis revealed that: tumor diameter >3 cm, presences of MVI and satellite nodules increased the risk of shortened recurrence time for the patients with CNLC Ⅰ a HCC (P<0.05); Factors including gamma-glutamyltranspeptidase level >60 U/L, tumor low differentiation, presences of MVI and satellite nodules were associated with shortened overall survival time for the patients with CNLC Ⅰ a HCC (P<0.05). The preoperative alpha-fetoprotein level ≥400 μg/L and tumor diameter >3 cm increased the risk of presence of MVI for the patients with CNLC Ⅰ a HCC [χ2=3.059, OR(95%CI)=2.357(1.047, 5.306), P=0.038; χ2=3.002, OR(95%CI)=2.301(1.026, 5.162), P=0.043]. ConclusionThe results of this study suggest that adopting corresponding strategies to address the risk factors affecting prognosis of patients with CNLC Ⅰ a HCC and the risk factors associated with MVI can have a significant clinical impact on improving surgical treatment outcomes for these patients.