循环肿瘤细胞与甲胎蛋白联合检测诊断原发性肝癌

Combined circulating tumor cell detection and AFP in diagnosing primary hepatocellular carcinoma

目的探讨循环肿瘤细胞（CTC）、甲胎蛋白（AFP）单独及联合检测诊断原发性肝癌的临床价值。方法纳入2013年11月至2015年9月在华中科技大学同济医学院附属同济医院行同种异体肝移植术的患者69例。所有患者术前抽血检测AFP，采用Cell Search System设备检测外周血CTC，并进行统计学分析。结果肝癌组患者（n=42）血液CTC和AFP水平明显高于良性肝病组（n=27），差异均有统计学意义（P〈0．05）。就单个肿瘤标志物而言，CTC的敏感度、特异度和准确度分别为69．0％、92．6％和78．3％，均高于AFP。AFP和CTC的受试者工作特征（ROC）曲线下面积分别为0．780和0．814。CTC和AFP联合检测其敏感度为83．3％，准确度为82．6％，均显著高于单项检测（P〈0．05）。此外，在AFP〈400μg／L的肝癌患者中，CTC阳性率为61．3％。结论CTC对肝癌的诊断效能优于AFP，联合检测CTC和AFP可提高肝癌的诊断敏感性。CTC对AFP〈400μg/L的肝癌患者有一定的诊断价值，CTC检测可提高AFP阴性肝癌患者的诊断率。

Objective To study the clinical value of circulating tumor cell （CTC） alone or in combination with AFP in diagnosing primary hepatocellular carcinoma （HCC）. Methods 69 patients who un- derwent liver transplantation in Tongji Hospital from November 2013 to September 2015 were enrolled into this study. The AFP levels were tested before operation, and preoperative blood samples were tested for CTCs using the CellSearchTM system. Results The levels of CTC and AFP in HCC patients （n = 42） were significantly higher than the benign liver disease group （ n = 27, P 〈 0.05 ）. The sensitivity, specificity and accuracy of CTC in diagnosing HCC were 69. 0%, 92. 6% and 78.3%, respectively, which were signifi- cantly higher than those of AFP. The areas under the receiver operating characteristic （ROC） curves of AFP and CTC were 0. 780 and 0. 814, respectively. The sensitivity and accuracy of combining CTC and AFP in diagnosing HCC were 83.3% and 82.6%, respectively, which were significantly higher than those detected by CTC or AFP alone （P 〈0. 05）. In AFP-negative HCC patients, the positive rate of CTC was 61.3%. Conclusions The diagnostic efficacy of CTC was better than AFP. Combined CTC and AFP markedly im- proved the diagnostic sensitivity of HCC. CTC had its special diagnostic value in AFP-negative HCC patients. The detection of CTC improved the diagnostic rate of AFP-negative HCC patients.