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.
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。
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.
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 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.
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。
Hepatoid adenocarcinoma is a rare extrahepatic malignant tumor with pathological characteristics similar to hepatocellular carcinoma. It is more common in the gastrointestinal tract and patients often have a history of hepatitis and elevated serum alpha fetoprotein (AFP). In clinical practice, patients may seek medical treatment due to liver lesions or elevated AFP, while primary gastrointestinal lesions are easily ignored. The author presents imaging findings of two patients who were diagnosed with hepatoid adenocarcinoma of stomach (HAS) due to elevated AFP in our hospital. By summarizing their clinical imaging characteristics and sorting out various clinical conditions that may cause elevated serum AFP, in order to improve the recognition and differential diagnosis of HAS.
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 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.