肝细胞癌患者血液中甲胎蛋白mRNA的临床意义

Clinical significance of alpha-fetoprotein mRNA in blood of patients with hepatocellular carcinoma.

作者信息

Cillo Umberto, Navaglia Filippo, Vitale Alessandro, Molari Alfiero, Basso Daniela, Bassanello Marco, Brolese Alberto, Zanus Giacomo, Montin Umberto, D'Amico Francesco, Ciarleglio Francesco Antonio, Carraro Amedeo, Bridda Alessio, Burra Patrizia, Carraro Paolo, Plebani Mario, D'Amico Davide Francesco

机构信息

Clinica Chirurgica I, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Via Giustiniani 2, Policlinico III Piano, 35128 Padova, Italy.

出版信息

Clin Chim Acta. 2004 Sep;347(1-2):129-38. doi: 10.1016/j.cccn.2004.04.032.

DOI:10.1016/j.cccn.2004.04.032

PMID:15313150

Abstract

BACKGROUND

Alpha-fetoprotein (AFP) messenger RNA (mRNA) in the blood reflects the presence of circulating hepatocellular carcinoma (HCC) cells and is a sensitive marker of HCC extrahepatic metastases. The specificity of this molecular marker and its correlation with the main HCC clinical-pathological parameters remains controversial, however.

METHODS

AFPmRNA was determined in 50 HCC patients and in 50 patients with diagnosis of cirrhosis (6), or colon (24) or, pancreatic (20) carcinoma. HCC patients with clinically evident extrahepatic metastasis were excluded. HCC diagnosis was confirmed in all patients by histology on percutaneous biopsies or surgical specimens; pathological grading was assessed at the same time.

RESULTS

AFPmRNA was positive in 20 HCC patients (40%) and in 18 patients without HCC (36%). The presence of AFPmRNA in the blood correlated significantly with cholestatic indices (p<0.01), nodule size (p=0.03), vascular invasion (p=0.006) and moderately or poorly differentiated HCC (p<0.0001). Moreover, survival analysis showed a significant impact of AFPmRNA detection on overall (p=0.04) and recurrence-free survival (p=0.0007) after a median follow-up of 17 months.

CONCLUSIONS

Although AFPmRNA is frequently detected in the blood, even in benign liver diseases or gastroenteric tumors, in HCC patients without clinical evidence of extrahepatic metastases it seemed to identify the biologically more aggressive tumors.

摘要

背景

血液中的甲胎蛋白（AFP）信使核糖核酸（mRNA）反映循环中的肝细胞癌（HCC）细胞的存在情况，并且是HCC肝外转移的敏感标志物。然而，这种分子标志物的特异性及其与主要HCC临床病理参数的相关性仍存在争议。

方法

对50例HCC患者以及50例诊断为肝硬化（6例）、结肠癌（24例）或胰腺癌（20例）的患者测定AFPmRNA。排除有临床明显肝外转移的HCC患者。所有患者均通过经皮活检或手术标本的组织学检查确诊为HCC；同时评估病理分级。

结果

20例HCC患者（40%）和18例非HCC患者（36%）的AFPmRNA呈阳性。血液中AFPmRNA的存在与胆汁淤积指数（p<0.01）、结节大小（p=0.03）、血管侵犯（p=0.006）以及中分化或低分化HCC（p<0.0001）显著相关。此外，生存分析显示，在中位随访17个月后，AFPmRNA检测对总生存期（p=0.可编辑文本04）和无复发生存期（p=0.0007）有显著影响。