Muller Carolyn Y, Cole Laurence A
USA hCG Reference Service(1), Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA.
Gynecol Oncol. 2009 Mar;112(3):663-72. doi: 10.1016/j.ygyno.2008.09.030. Epub 2008 Nov 12.
Few molecules have created so much confusion as the hCG series of molecules. Here we present a comprehensive review of hCG as a tumor marker, of hCG and cancer and modern perspectives on the multiplicity of hCG, and its appropriate use in the management of gynecological malignancies and gestational trophoblastic diseases. The complexity of hCG is better understood. There is regular hCG produced by syncytiotrophoblast cells in pregnancy and by hydatidiform moles. This hormone functions to advance uterine angiogenesis and promote progesterone production by corpus luteal cells. Hyperglycosylated hCG is an independent molecule to regular hCG, it varies significantly from hCG in structure and is produced by cytotrophoblast cells. It is an autocrine or cytokine which functions to promote growth, invasion and malignancy. It is an absolute marker of invasive mole and invasive choriocarcinoma. Hyperglycosylated hCG is invaluable in the diagnosis and management of gestational trophoblastic diseases. The free beta-subunit of hCG is also an autocrine or cytokine and is produced in most gynecologic malignancies. Serum free beta-subunit or its urinary degradation product beta-core fragment is produced by 68% of ovarian, 51% of endometrial and 46% of cervical malignancies. Free beta-subunit enhances growth and invasion in all these malignancies leading to poor prognosis. Free beta-subunit and beta-core fragment are good tumor markers for these malignancies. There are few circumstances that create more confusion than the patient presenting with persistent low positive hCG results in the absence of pregnancy and absence of obvious malignancies. The series of hCG molecules as tumor markers will be reviewed to help the clinician best diagnose these often difficult clinical problems.
很少有分子像人绒毛膜促性腺激素（hCG）系列分子那样引发如此多的困惑。在此，我们对hCG作为肿瘤标志物、hCG与癌症以及hCG多样性的现代观点进行全面综述，以及其在妇科恶性肿瘤和妊娠滋养细胞疾病管理中的合理应用。hCG的复杂性得到了更好的理解。在妊娠时合体滋养层细胞以及葡萄胎会产生正常hCG。这种激素的作用是促进子宫血管生成，并促进黄体细胞产生孕酮。高糖基化hCG是一种独立于正常hCG的分子，其结构与hCG有显著差异，由细胞滋养层细胞产生。它是一种自分泌因子或细胞因子，具有促进生长、侵袭和恶变的作用。它是侵袭性葡萄胎和侵袭性绒毛膜癌的绝对标志物。高糖基化hCG在妊娠滋养细胞疾病的诊断和管理中具有重要价值。hCG的游离β亚基也是一种自分泌因子或细胞因子，在大多数妇科恶性肿瘤中都会产生。血清游离β亚基或其尿液降解产物β核心片段在68%的卵巢癌、51%的子宫内膜癌和46%的宫颈癌中产生。游离β亚基在所有这些恶性肿瘤中都会促进生长和侵袭，导致预后不良。游离β亚基和β核心片段是这些恶性肿瘤的良好肿瘤标志物。很少有情况比患者在未怀孕且无明显恶性肿瘤的情况下出现持续低阳性hCG结果更令人困惑。本文将对作为肿瘤标志物的hCG分子系列进行综述，以帮助临床医生更好地诊断这些常常棘手的临床问题。
