Objective The usefulness of measurement of nuclear DNA content elevation for diagnosis of early hepatocellular carcinoma was evaluated by a study of 186 patients with liver cirrhosis. Methods Nuclear DNA content was measured using an automatic image analysis system.Results ①Hepatocellular carcinoma was found in 37 patients during 10 years follow-up, the cumulative incidence of hepatocellular carcinoma was 19.89%. ②The incidence of hepatocellular carcinoma increased with the increase of the patterns of α-fetoprotein (AFP), 5c exceeding rate (5cER), FORM PE, but positive predictive value of 5cER was the highest of three parameters, the difference among all groups was significant by the χ2 test (Ｐ＜0.05). ③When 5cER joined AFP for monitoring development of hepatocellular carcinoma, the incidence of hepatocellular carcinoma was 72.00%, which was significantly higher than that of 5cER or AFP alone, the difference between groups was highly significant (Ｐ＜0.01). Conclusion Patients who had 5cER levels of 3%-5% or more, who had transient increases in 5cER or who had both, should be treated as being in a super-highrisk group for hepatocellular carcinoma. Frequent and careful examination by ultrasonography of such patients is recommended. It is important that measurement of 5cER join with AFP in cirrhotic patients monitored for early development of hepatocellular carcinoma.
【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.
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.
Objective To explore the differential expressions of seven microRNAs between hepatocellular carcinoma (HCC) and adjacent nontumorous tissues (NT), analyze the correlations between differential expressing microRNAs and the levels of tumor markers in serum, and furnish evidence for novel diagnostic and prognostic tool of HCC. Methods Real-time quantitative PCR technique was used to measure the differential expressions of seven microRNAs in HCC tissues compared with NT. Results Compared with NT, the relative expressions of seven microRNAs in HCC tissues manifested statistical difference (Plt;0.05). MiR-34c, miR-21, miR-16, and miR-10b presented higher expressions in the HCC samples than those in the NT samples, while miR-200a, miR-148b, and miR-Let-7i demonstrated lower expressions in the HCC samples than those in the NT samples. In addition, miR-200a and miR-148b were markedly down-regulated in the HCC tissues than those in the NT. The differential expressions of miR-200a in HCC compared with NT samples was correlated with serum AFP level of the patients (r=0.848 9, Plt;0.01), while the differential expressions of the other six microRNAs had no correlation with the levels of tumor markers in serum (Pgt;0.05). Conclusions There are differential expressions of microRNAs between HCC and NT. MiR-200a may serve as a novel diagnostic and prognostic tool of HCC.
ObjectivesTo evaluate the accuracy of liver cancer screening techniques to inform screening intervention and early diagnosis.MethodsWe searched PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data, CBM, VIP databases to collect relevant diagnostic accuracy studies of screening technologies for liver cancer from January 1980 to December 2017. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Meta-Disc 1.4 software.ResultsA total of 54 publications with 47 728 individuals were included. In terms of pooled sensitivity from the meta-analysis, it was estimated as 0.71 (95%CI 0.70 to 0.72), 0.57 (95%CI 0.56 to 0.59) and 0.43 (95%CI 0.41 to 0.45); the pooled specificity was estimated as 0.92 (95%CI 0.92 to 0.93), 0.95 (95%CI 0.94 to 0.96) and 0.95 (95%CI 0.94 to 0.96); the pooled positive likelihood ratio was 5.65 (95%CI 4.37 to 7.30), 13.24(95%CI 4.25 to 41.22) and 11.39 (95%CI 4.01 to 32.35); the pooled negative likelihood ratio was 0.35 (95%CI 0.31 to 0.39), 0.38 (95%CI 0.29 to 0.52) and 0.49 (95%CI 0.39 to 0.62); the diagnosis odds ratio was 17.23 (95%CI 12.26 to 24.20), 33.79 (95%CI 12.65 to 90.24) and 24.41(95%CI 9.23 to 64.53) for AFP alone with cut-off of 20, 200 and 400 ng/mL, respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.65 (95%CI 0.62 to 0.69), 0.97 (95%CI 0.97 to 0.97), 16.48 (95%CI 9.55 to 28.42), 0.27 (95%CI 0.18 to 0.42) and 64.54 (95%CI 30.16 to 138.11) for ultrasound examination alone. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.96 (95%CI 0.94 to 0.98), 0.96 (95%CI 0.96 to 0.96), 10.76 (95%CI 2.62 to 44.27), 0.07 (95%CI 0.02 to 0.22) and 160.59 (95%CI 31.61 to 816.03) for the combined strategy.ConclusionFor liver cancer screening technologies, the overall accuracy of serum AFP test alone is the optimum at cut-off of 20 ng/mL, and the sensitivity increased substantially when combined with ultrasound examination.
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.
The authors presented CT manifestations of a patient with hepatoid adenocarcinoma of gallbladder with liver involvement and briefly described the clinical features, imaging manifestations, and differential diagnosis of the disease in order to enhance the readers’ better awareness of the imaging manifestations, thus to reduce the misdiagnosis of the disease.
