Shi Wei, Jin Wen, Hong Lang, Wu Huo, Hu Shifeng
Department of Pathology, Tongling Polytechnic, Tongling, Anhui, China.
Department of Physiology, Tongling Polytechnic, Tongling, Anhui, China.
Medicine (Baltimore). 2025 Mar 21;104(12):e41899. doi: 10.1097/MD.0000000000041899.
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the 2 major types of primary liver cancer, differing significantly in etiology, treatment strategies, and prognosis despite their common hepatic origin. Accurate preoperative differentiation between HCC and ICC is critical for optimizing treatment and improving patient outcomes. However, traditional diagnostic methods, including imaging and tumor markers, have limitations in sensitivity and specificity, necessitating the exploration of novel diagnostic approaches. This retrospective study included 165 patients diagnosed with HCC (n = 87) or ICC (n = 78) between January 2023 and January 2024. Preoperative data, including routine blood tests and tumor markers (e.g., alpha-fetoprotein [AFP], carbohydrate antigen 19-9 [CA19-9], carcinoembryonic antigen [CEA]), were collected. Blood routine parameters, such as white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), were analyzed. Univariate and multivariate logistic regression analyses were conducted to identify independent diagnostic factors. A predictive model was constructed and its diagnostic performance evaluated using receiver operating characteristic curves. Subgroup analyses were performed to investigate diagnostic efficiency in different patient subsets. AFP and CA19-9 emerged as key tumor markers for differentiating HCC and ICC. AFP levels were significantly higher in HCC patients (P < .001), whereas CA19-9 levels were markedly elevated in ICC patients (P < .001). Among blood routine parameters, elevated WBC (P < .001), monocyte count (P = .005), NLR (P = .02), and monocyte ratio (P = .012) were associated with an increased risk of ICC, while a higher LMR was protective against ICC (P = .006). The multivariate logistic regression model demonstrated robust diagnostic accuracy, with an area under the curve (AUC) of 0.791. Subgroup analyses revealed superior diagnostic performance at higher levels of AFP (≥200 ng/mL, AUC = 0.90) and CA19-9 (≥37 U/mL, AUC = 0.91). The combination of blood routine parameters and tumor markers demonstrates high diagnostic efficacy in preoperatively differentiating HCC and ICC. Key markers, including AFP and CA19-9, along with inflammatory and immune-related blood parameters such as WBC, NLR, and LMR, significantly enhance diagnostic accuracy. This study provides valuable insights into refining diagnostic strategies and supports individualized treatment planning for patients with primary liver cancer.
肝细胞癌（HCC）和肝内胆管癌（ICC）是原发性肝癌的两种主要类型，尽管它们都起源于肝脏，但在病因、治疗策略和预后方面存在显著差异。术前准确区分HCC和ICC对于优化治疗和改善患者预后至关重要。然而，包括影像学和肿瘤标志物在内的传统诊断方法在敏感性和特异性方面存在局限性，因此需要探索新的诊断方法。这项回顾性研究纳入了2023年1月至2024年1月期间诊断为HCC（n = 87）或ICC（n = 78）的165例患者。收集了术前数据，包括血常规检查和肿瘤标志物（如甲胎蛋白[AFP]、糖类抗原19-9[CA19-9]、癌胚抗原[CEA]）。分析了血常规参数，如白细胞计数（WBC）、中性粒细胞与淋巴细胞比值（NLR）和淋巴细胞与单核细胞比值（LMR）。进行单因素和多因素逻辑回归分析以确定独立的诊断因素。构建了预测模型，并使用受试者工作特征曲线评估其诊断性能。进行亚组分析以研究不同患者亚组中的诊断效率。AFP和CA19-9是区分HCC和ICC的关键肿瘤标志物。HCC患者的AFP水平显著更高（P <.001），而ICC患者的CA19-9水平明显升高（P <.001）。在血常规参数中，WBC升高（P <.001）、单核细胞计数升高（P =.005）、NLR升高（P =.02）和单核细胞比例升高（P =.012）与ICC风险增加相关，而较高的LMR对ICC有保护作用（P =.006）。多因素逻辑回归模型显示出强大的诊断准确性，曲线下面积（AUC）为0.791。亚组分析显示，在较高的AFP水平（≥200 ng/mL，AUC = 0.90）和CA19-9水平（≥37 U/mL，AUC = 0.91）下诊断性能更佳。血常规参数和肿瘤标志物的联合在术前区分HCC和ICC方面显示出高诊断效能。包括AFP和CA19-9在内的关键标志物，以及WBC、NLR和LMR等炎症和免疫相关的血液参数，显著提高了诊断准确性。本研究为完善诊断策略提供了有价值的见解，并支持原发性肝癌患者的个体化治疗规划。
