Izzo F, Cremona F, Delrio P, Leonardi E, Castello G, Pignata S, Daniele B, Curley S A
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Ann Surg Oncol. 1999 Mar;6(2):178-85. doi: 10.1007/s10434-999-0178-1.
Worldwide, the majority of cases of hepatocellular cancer (HCC) arise in individuals with chronic hepatitis B or C virus infections. Early detection of HCC in these patients provides the best chance for curative treatment, but serum alfa fetoprotein (AFP) levels are frequently normal in patients with small HCCs. The purpose of this study was to determine: (1) whether soluble interleukin-2 receptor (sIL-2R) levels are elevated more frequently than AFP levels in HCC patients and (2) whether sIL-2R levels are useful as a marker of successful treatment and recurrence of disease.
We are performing a prospective screening program with high-risk, chronic hepatitis virus-infected patients to detect HCC. Patients are screened by using abdominal ultrasonography, serum AFP measurements, and serum sIL-2R measurements. Normal serum sIL-2R levels were established using results from 174 healthy volunteers with no evidence of hepatitis virus infection or HCC.
HCC has been diagnosed in 99 patients from a cohort of 1520 screened patients. Serum AFP levels were elevated in 79 patients (80%), whereas sIL-2R levels were elevated in 98 of the 99 patients (99%, P < .01, chi2 test). For 27 of the 99 patients (27%), HCC was diagnosed at an early stage and complete resection or ablation was performed. Serum sIL-2R levels returned to normal in all 27 patients after treatment, whereas AFP levels remained slightly elevated in 5 of the 27 (18%). Among the 16 patients in this group of 27 who developed recurrent HCC, sIL-2R levels became elevated in all 16, whereas AFP levels were elevated at diagnosis of recurrence for only 10 (P < .05).
This study with chronic hepatitis B or C virus-infected patients indicates that (1) serum sIL-2R levels are abnormal in patients with HCC with a significantly greater frequency, compared with AFP levels, and (2) sIL-2R levels are a more sensitive marker of successful treatment and recurrence of HCC. Based on these findings, we now use serum sIL-2R measurements both to screen high-risk patients and to monitor treatment responses in patients with hepatitis who develop HCC.
在全球范围内，大多数肝细胞癌（HCC）病例发生于慢性乙型或丙型肝炎病毒感染患者。在这些患者中早期检测出HCC为治愈性治疗提供了最佳机会，但小肝癌患者的血清甲胎蛋白（AFP）水平常常正常。本研究的目的是确定：（1）HCC患者中可溶性白细胞介素-2受体（sIL-2R）水平升高的频率是否比AFP水平更高；（2）sIL-2R水平是否可作为治疗成功及疾病复发的标志物。
我们正在对高危慢性肝炎病毒感染患者开展一项前瞻性筛查计划以检测HCC。通过腹部超声检查、血清AFP检测及血清sIL-2R检测对患者进行筛查。利用174名无肝炎病毒感染或HCC证据的健康志愿者的检测结果确定正常血清sIL-2R水平。
在1520名接受筛查的患者队列中，已确诊99例HCC。79例患者（80%）血清AFP水平升高，而99例患者中有98例（99%，P <.01，卡方检验）sIL-2R水平升高。99例患者中有27例（27%）在早期诊断出HCC并进行了完整切除或消融。治疗后所有27例患者的血清sIL-2R水平均恢复正常，而27例中有5例（18%）的AFP水平仍略有升高。在这27例发生复发性HCC的患者中，16例患者的sIL-2R水平均升高，而复发诊断时AFP水平升高的仅10例（P <.05）。
这项针对慢性乙型或丙型肝炎病毒感染患者的研究表明，（1）与AFP水平相比，HCC患者血清sIL-2R水平异常的频率显著更高；（2）sIL-2R水平是HCC治疗成功及复发更敏感的标志物。基于这些发现，我们现在使用血清sIL-2R检测来筛查高危患者并监测发生HCC的肝炎患者的治疗反应。
