原发性肝癌雌激素受体表达及内分泌治疗

Estrogen receptor expression in hepatocellular carcinoma and tamoxifen endocrine therapy

目的研究原发性肝癌雌激素受体（ＥＲ）的表达及内分泌治疗的临床价值．方法应用Ｌｅｅ氏荧光配体细胞化学法检测４１例手术病理确诊的原发性肝癌ＥＲ的表达．本组男３８例，女３例，年龄２５岁～７２岁．同时检测肝癌的组织类型、分化程度、肿瘤大小、血清ＡＦＰ及ＣＥＡ．６例ＥＲ阳性者采用他莫昔芬治疗（每次２０ｍｇ，２次／ｄ，长期服用）并观察疗效．结果肝癌组织ＥＲ阳性２０／４１例，阳性率４８８％．ＥＲ阳性率与患者年龄、性别、ＡＦＰ、ＣＥＡ含量及组织类型（梁状型ＥＲ阳性４５０％，腺样型３３３％，实体型７１４％，硬化型６６７％，透明细胞型２５０％；Ｐ＞００５）无明显关系，与肿瘤体积（≥１０ｃｍ，ＥＲ阳性率７５０％；＜１０ｃｍ，ＥＲ阳性２３８％；Ｐ＜００１）和分化程度（分化好２６例，ＥＲ阳性３４６％；分化差１５例，ＥＲ阳性７３３％；Ｐ＜００５）有显著关系．本组ＥＲ阳性病例中６例经他莫昔芬内分泌治疗有效５／６（８３３％），其中４例ＡＦＰ下降．

AIM To study the expression of estrogen receptor (ER) and the clinical effectiveness of endocrine therapy in hepatocellular carcinoma (HCC). METHODS The estrogen receptor of 41 patients with hepatocellular carcinoma was assayed by the Lee′s fluorescein_labeled ligand cytochemical method. The patients included 38 men and 3 women, aged 25～72 years. Histologic types of the tumor, degree of differentiation, tumor size and serum levels of α_fetoprotein (AFP) or carcinoembryonic antigen (CEA) were assayed at the same time. Six of them with positive ER were treated constantly with tamoxifen (20mg bid) and the therapeutic effect was observed. RESULTS Twenty of 41 patients (48 78%) had positive ER, which was not significantly related to sex, age, AFP or CEA levels and histopathologic types of the tumor (trabecular pattern accounts for 45 0%, adenoid pattern 33 3%, solid pattern 71 4% cirrhotic pattern 66 7%, clear cell pattern 25 0%; P >0 05), but related to tumor size (≥10cm, ER positive 75%, <10cm, 23 8%; P <0 01) and degree of differentiation (26 well_differentiatied, ER positive 34 6%; 15 poor_differentiatied, ER positive 73 3%, P <0 05). Tamoxifen endocrine therapy was effective in 5/6 ER positive patients, AFP decreased in 4 of them. CONCLUSION Tamoxifen endocrine therapy was effective for the ER positive patients with HCC.