Okuda Hiroaki, Shiratori Keiko, Yamamoto Masakazu, Takasaki Ken, Nakano Masayuki
Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
J Gastroenterol Hepatol. 2006 May;21(5):869-73. doi: 10.1111/j.1440-1746.2006.04257.x.
Some patients who are seropositive for lectin-reactive alpha-fetoprotein (AFP-L3) have intrahepatic cholangiocarcinoma (ICC). There have been no studies regarding the features of ICC patients seropositive for AFP-L3. Thus, the purpose of the present paper was to compare the features of ICC patients from the viewpoint of two different tumor markers, AFP-L3 and carbohydrate antigen (CA) 19-9.
The ICC patients who underwent hepatectomy (n = 51) were divided into three groups, and their clinicopathologic features were compared: (i) group A, seropositive for AFP-L3 >or= 15%; (ii) group B, seropositive for CA 19-9 >or= 37 U/mL; and (iii) group C, seronegative for both AFP-L3 and CA 19-9. The features of combined hepatocellular and cholangiocarcinoma (n = 11) were also studied.
Group A had a higher positivity rate for hepatitis viruses than group B (60%vs 20%, P < 0.05). More patients in group A were misdiagnosed as having hepatocellular carcinoma (HCC) at surgery (70%vs 5.7%, P < 0.001) who also had chronic liver disease (80%vs 25.7%, P < 0.01) than in group B. Seven, 10 and 11 of the 11 patients with combined hepatocellular and cholangiocarcinoma were seropositive for AFP-L3, CA 19-9 and hepatitis viruses, respectively. Ten were diagnosed as having HCC at surgery and nine had chronic liver disease.
Patients with ICC seropositive for AFP-L3 and those with combined hepatocellular and cholangiocarcinoma have features close to HCC. The present study has, for the first time, identified a subgroup of ICC patients, seropositive for AFP-L3, having features close to HCC that are very different from those of the classical ICC patients seropositive for CA 19-9.
一些凝集素反应性甲胎蛋白（AFP-L3）血清学阳性的患者患有肝内胆管癌（ICC）。目前尚无关于AFP-L3血清学阳性的ICC患者特征的研究。因此，本文的目的是从两种不同肿瘤标志物AFP-L3和糖类抗原（CA）19-9的角度比较ICC患者的特征。
将接受肝切除术的ICC患者（n = 51）分为三组，比较其临床病理特征：（i）A组，AFP-L3血清学阳性≥15%；（ii）B组，CA 19-9血清学阳性≥37 U/mL；（iii）C组，AFP-L3和CA 19-9血清学均为阴性。还研究了肝细胞癌合并胆管癌患者（n = 11）的特征。
A组肝炎病毒阳性率高于B组（60%对20%，P < 0.05）。与B组相比，A组更多患者在手术时被误诊为肝细胞癌（HCC）（70%对5.7%，P < 0.001），且患有慢性肝病的患者也更多（80%对25.7%，P < 0.01）。11例肝细胞癌合并胆管癌患者中，分别有7例、10例和11例AFP-L3、CA 19-9和肝炎病毒血清学阳性。10例在手术时被诊断为HCC，9例患有慢性肝病。
AFP-L3血清学阳性的ICC患者以及肝细胞癌合并胆管癌患者具有与HCC相似的特征。本研究首次确定了AFP-L3血清学阳性的ICC患者亚组，其具有与经典的CA 19-9血清学阳性的ICC患者非常不同的、与HCC相似的特征。
