Saffroy Raphaël, Pham Patrick, Reffas Maâmar, Takka Mohamed, Lemoine Antoinette, Debuire Brigitte
Service de Biochimie, Biologie Moléculaire et Toxicologie, Hôpital Universitaire Paul Brousse, Université Paris-Sud, UMR-S602, Villejuif, INSERM, Villejuif, France.
Clin Chem Lab Med. 2007;45(9):1169-79. doi: 10.1515/CCLM.2007.262.
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. Cirrhosis caused by hepatitis B virus, hepatitis C virus or chronic alcohol intake is associated with major risk. Systematic screening for HCC of asymptomatic patients with cirrhosis is needed for earlier detection of small tumors requiring treatment (liver transplantation, surgical resection, percutaneous techniques). The recommended screening strategy among cirrhotic patients is based on regular liver ultrasonography associated with serum alpha-fetoprotein (AFP) assay. As the performance of AFP is not satisfactory, additional tumoral markers are proposed (des-gamma-carboxyprothrombin, glycosylated AFP-L3 fraction). Currently, diagnosis of HCC in cirrhotic patients includes non-invasive tests (imaging after contrast administration, AFP assay); diagnostic biopsy is performed when imaging is limited. After treatment, tumor recurrence is assessed by regular follow-up (AFP assay and imaging). Despite the lack of accurate markers, recent developments in genomic and proteomic approaches will allow the discovery of new biomarkers for primary tumors, as well as for recurrence. This review summarizes the current state of biomarkers for screening, diagnosis and follow-up of HCC, and highlights new perspectives in the field.
肝细胞癌（HCC）是全球第五大常见癌症。由乙型肝炎病毒、丙型肝炎病毒或长期饮酒引起的肝硬化是主要危险因素。需要对无症状肝硬化患者进行HCC系统筛查，以便更早发现需要治疗的小肿瘤（肝移植、手术切除、经皮技术）。肝硬化患者推荐的筛查策略基于定期肝脏超声检查结合血清甲胎蛋白（AFP）检测。由于AFP的表现不尽人意，因此提出了其他肿瘤标志物（脱γ-羧基凝血酶原、糖基化AFP-L3组分）。目前，肝硬化患者HCC的诊断包括非侵入性检查（对比剂注射后的影像学检查、AFP检测）；当影像学检查受限则进行诊断性活检。治疗后，通过定期随访（AFP检测和影像学检查）评估肿瘤复发情况。尽管缺乏准确的标志物，但基因组学和蛋白质组学方法的最新进展将有助于发现原发性肿瘤以及复发的新生物标志物。本综述总结了HCC筛查、诊断和随访生物标志物的现状，并强调了该领域的新观点。
