凝血功能5项联合甲胎蛋白在原发性肝癌诊断中的价值

目的分析凝血功能5项联合甲胎蛋白在原发性肝癌诊断中的价值。方法选2019年1月到2021年1月泰州市第四人民医院收治的原发性肝癌患者110例为研究组,另选取同期体检志愿者60例为对照组。检测两组凝血功能5项、甲胎蛋白水平。结果与对照组相比,研究组凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)较长,D-二聚体、甲胎蛋白(AFP)水平较高,纤维蛋白原(FIB)水平较低(P<0.05)。原发性肝癌Ⅰ~Ⅱ期、高分化、未发生淋巴结转移、肿瘤直径<4、单个结节、未出现静脉侵犯患者D-二聚体、TT、PT、APTT、AFP均低于Ⅲ~Ⅳ期、中低分化、淋巴结转移、肿瘤直径≧4、多发结节、出现静脉侵犯患者,FIB则相反(均P<0.05)。将性别、年龄等因素控制后,D-二聚体、TT、PT、APTT、AFP与临床分期、组织分化程度、淋巴结转移、肿瘤直径、肿瘤部位特点、静脉侵犯呈正相关,FIB与临床分期、组织分化程度、淋巴结转移、肿瘤直径、肿瘤部位特点、静脉侵犯呈负相关(P<0.05)。6项联合对原发性肝癌的诊断价值高于D-二聚体、TT、PT、APTT、FIB、AFP蛋白单项检测(P<0.05)。结论原发性肝癌患者TT、PT、APTT较长,D-二聚体、AFP水平较高,FIB水平较低,且D-二聚体、TT、PT、APTT、AFP表达情况与临床分期、组织分化程度、淋巴结转移、肿瘤直径、肿瘤部位特点、静脉侵犯相关,联合检测对原发性肝癌诊断价值较高。

纳米石墨适配体传感器结合酶信号放大检测甲胎蛋白

利用纳米石墨-适配体传感器结合脱氧核糖核酸酶(DNase I)信号放大策略检测了肿瘤标志物甲胎蛋白(AFP)。通过将纳米石墨(NG)和DNase I加入到适体(aptamer)溶液中合成了一种新型的荧光传感器NG/Aptamer。加入AFP后,AFP/aptamer复合物的形成导致aptamer从NG表面脱离,随后aptamer被DNase I分解,目标AFP被释放出来进行新一轮循环,从而实现了检测信号的明显放大。在最佳条件下,AFP浓度在3~150 pg·mL^(-1)范围内与荧光强度呈线性关系,检测限为2.556 pg·mL^(-1)。此外,所开发的传感器对AFP具有高度特异性,不会受到其他结构类似物质的干扰。该传感器也可应用于人血清样本中AFP的检测,回收率为95.1~103.8%。

诱骗受体3在肝癌临床诊疗中的研究进展

肝癌是一种严重的全球性疾病,其发病率和死亡率较高。诱骗受体3(DcR3)是一种肿瘤坏死因子超家族成员,其在多种肿瘤中表达异常。尤其在肝癌中,DcR3的表达水平显著高于正常肝组织,因此联合甲胎蛋白检测可作为一种早期诊断方法。DcR3也可以作为评估肝癌治疗效果的指标,其表达水平与疾病进程和患者预后密切相关。同时,DcR3的发现也为肝癌的靶向治疗提供了新靶点。通过抑制DcR3的表达或阻断其信号转导,抑制肝癌细胞的增殖和侵袭,为治疗肝癌提供了一种可能的新途径。未来通过深入研究DcR3的作用机制,开发针对DcR3的诊疗策略,有望为肝癌的个性化诊疗提供新的可能。

血小板与淋巴细胞比值和甲胎蛋白对肝移植患者预后的预测价值

目的评估血小板与淋巴细胞比值(PLR)和甲胎蛋白(AFP)对肝移植患者预后的预测价值。方法选取2016年1月—2021年12月在宁波大学附属李惠利医院进行同种异体肝移植术的患者221例,收集其一般资料、相关检测指标及随访信息。利用受试者工作特征曲线计算曲线下面积(AUC)并获取最佳截断值,并根据最佳截断值将PLR和AFP分别分为高和低两组。采用Kaplan-Meier法绘制生存曲线,采用LogRank检验比较组间生存率的差异。采用Cox比例风险回归模型进行单因素和多因素分析。结果肝移植患者PLR和AFP的AUC分别为0.706、0.710(P<0.05)。高PLR组52例,1、3、5年生存率分别为96.2%、79.1%、69.0%;低PLR组169例,1、3、5年生存率分别为98.2%、94.2%、92.2%。高AFP组55例,1、3、5年生存率分别为94.5%、75.1%、69.2%;低AFP组166例,1、3、5年生存率分别为98.8%、95.2%、91.9%。单因素Cox回归分析显示,年龄、住院时间、肝癌、凝血酶原时间、Child-Turcotte-Pugh分级、PLR水平和AFP水平是肝移植患者预后的影响因素(P<0.05);多因素Cox回归分析显示,住院时间长、高PLR、高AFP是影响肝移植患者预后的独立危险因素(P<0.05)。结论住院时间长、高PLR、高AFP是影响肝移植患者预后的独立危险因素,临床上可将其作为简便、可行的预后评估工具。

CA19-9、CEA、AFP检测联合128层MSCT对早期食管癌的诊断效果

目的 分析糖链抗原19-9(CA19-9)、癌胚抗原(Carcinoembryonic antigen,CEA)、甲胎蛋白(AFP)检测联合128层多层螺旋(CT(MSCT)对早期食管癌的诊断效果。方法 收集本院2021年6月至2023年10月收治的92例食管癌患者的临床资料(食管癌组)。另同期选取在本院进行健康体检的63例健康体检者作为对照组。观察食管癌大小、形态、密度等CT征象,比较不同人群CA19-9、CEA、AFP水平;并绘制受试者工作特征曲线(ROC),分析MSCT联合CA19-9、CEA、AFP对早期食管癌的诊断价值。结果 食管癌组CA19-9、CEA、AFP水平均明显高于对照组(P<0.05)。食管癌Ⅰ-Ⅱ期患者血清CA19-9、CEA、AFP1水平明显低于Ⅲ-Ⅳ期者(P<0.05)。ROC曲线示,MSCT、CA19-9、CEA、AFP四者联合检测曲线下面积(AUC)、敏感度、特异度分别为0.915、0.965、0.863,均高于各项指标单独检测。结论 CA19-9、CEA、AFP在食管癌中均呈高表达,可能与食管癌发生、发展有关;且上述因子联合MSCT检查可提高早期食管癌诊断价值。

立体定向放疗联合信迪利单抗和贝伐珠单抗治疗不可切除原发性肝癌的效果分析

目的探讨立体定向放疗联合信迪利单抗和贝伐珠单抗治疗不可切除肝癌的效果、安全性及预后指标。方法选取2022年3月—12月在中国人民解放军总医院第五医学中心放射治疗科接受立体定向放疗联合信迪利单抗和贝伐珠单抗类似物(双达方案)治疗的42例不可切除原发性肝癌患者,给予计划靶区处方剂量为36~50 Gy,分5~6次,连续照射,后序贯双达方案治疗,每3周为1个疗程,直至出现肿瘤进展或严重不良反应。采用Kaplan-Meier法计算总生存率和无进展生存率,并采用Log-rank检验进行比较;Cox比例风险模型分析影响预后的相关因素。结果中位随访时间为21.6个月,客观缓解率为69%,疾病控制率为85.7%,中位无进展生存期为10.0个月(95%CI:6.7~13.0),中位总生存期为23.3个月(95%CI:14.7~31.8)。不良反应多为1~2级,未发生致命性不良反应。治疗后6~8周AFP应答组中位总生存期显著优于AFP未应答组(未达到vs 11.8个月,P=0.007)。多因素分析显示AFP应答与患者良好的预后相关(HR=0.31,95%CI:0.13~0.75,P=0.009)。结论对于不可切除肝癌患者,立体定向放疗联合双达方案可改善患者生存且安全性可控,治疗后6~8周AFP水平下降>50%可作为潜在预后指标。

MRI联合AFP-L3预测肝癌射频消融术后复发的研究

目的 本研究探讨血清凝集素反应性甲胎蛋白(serum lectin-reactive alpha-fetoprotein,AFP-L3)结合M RI预测经皮射频消融(radiofrequency ablation,RFA)后肝癌复发的价值。方法 纳入94例肝癌RFA患者和82名健康人。磁共振成像记录表观弥散系数(apparent diffusion Coefficient, ADC),定量测定所有受试者血清AFP-L3的浓度,分析其与治疗后临床疗效的相关性和预测作用。结果 肝癌患者血清AFP-L3水平高于健康对照组,ADC值低于健康对照组。肿瘤残留者的ADC值低于完全消融者,血清AFP-L3水平高于完全消融者,联合检测ADC值和血清AFP-L3水平诊断完全消融的敏感性和特异度分别为87.50%和87.18%,肿瘤结节数、肿瘤直径、AFP、AFP-L3和有无肝硬变均为肝癌术后1年内复发的独立危险因素。ADC值与血清AFP-L3水平联合检测对预测肝癌复发的敏感性为92.86%,特异性为69.62%。结论 ADC值与血清AFP-L3检测相结合,对射频治疗后肝癌的完全消融和复发有较好的预测作用。

Computed morphometric analysis and expression of alpha fetoprotein in hepatocellular carcinoma and its related lesion

INTRODUCTION Hepatocellular carcinoma(HCC)is closely relatedwith hepatitis and cirrhosis.In order to investigatethe pathogenesis and early pathologic diagnosis ofHCC,HCC and related lesions were analyzedqualitively and quantitively by automatic imageanalysor and immunohistochemical assay.

核磁共振联合血清CK、AFP诊断对植入型凶险性前置胎盘应用子宫动脉栓塞术的价值分析

目的:探讨核磁共振联合血清CK、AFP诊断对植入型凶险性前置胎盘术前应用子宫动脉栓塞术的价值。方法:选取2022年1月至2023年12月本院收治的90例凶险性前置胎盘患者,按照术后病理学诊断结果分为胎盘植入组(48例)和非胎盘植入组(42例),比较两组患者血清CK、AFP水平,并结合核磁共振联合血清CK、AFP水平,分别采取针对性的手术方式。比较核磁共振、血清学诊断及两者联合诊断相关指标。另选同期以常规剖宫产术、病理学诊断为凶险性前置胎盘患者48例为对照组,比较植入组和对照组术后不良事件的发生率。结果:植入组患者血清CK、AFP水平明显高于非植入组(P<0.05);核磁共振联合血清检查对植入型凶险性前置胎盘的敏感度、准确度、阴性预测值均明显高于单独核磁共振或血清学检查(P<0.05);植入组患者术后不良事件发生率明显低于对照组(P<0.05)。结论:核磁共振联合血清CK、AFP检查对于植入型凶险性前置胎盘的诊断具有一定价值,可结合评估情况,决定是否应用术前子宫动脉栓塞术,术后不良事件发生率低。

Elevated serum alpha fetoprotein levels promote pathological progression of hepatocellular carcinoma

AIM:To investigate the biological role of alpha fetoprotein (AFP) and its clinical signif icance in carcinogenesis of hepatocellular carcinoma (HCC).METHODS:Clinical analysis of HCC patients and im-munohistochemical examination were conducted to evaluate the relationship between serum AFP level and patient mortality. Confocal microscopy,Western blotting, dimethylthiahzolyl-2,5-diphenyl-tetrazolium bromide,Cell Counting Kit-8 assays and flow cytometry were performed to explore the possible mechanism.RESULTS: Among the 160 HCC patients enrolled in this study,130 patients survived 2 years (81.25%),with a survival rate of 86.8% in AFP < 2 0 μg/L group,88.9% in AFP 20-250 μg/L group,and 69.6% in AFP > 250 μg/L group, demonstrating a higher mortality rate in HCC patients with higher AFP levels. Surgical treatment was benef icial only in patients with low AFP levels.The mortality rate of HCC patients with high AFP levels who were treated surgically was apparently higher than those treated with conservative management.The results of immunohistochemistry showed that AFP and AFP receptor were merely expressed in tissues of HCC patients with positive serum AFP.Consistently,in vitro analysis showed that AFP and AFPS were expressed in HepG2 but not in HLE cells. AFP showed a capability to promote cell growth,and this was more apparent in HepG2 cells,in which the proliferation was increased by 3.5 folds. Cell cycle analysis showed that the percent-age of HepG2 cells in S phase after exposure to AFP was modestly increased.CONCLUSION:HCC patients with higher AFP levels show a higher mortality rate,which appears to be attributable to the growth promoting properties of AFP.

The relationship between second trimester alpha fetoprotein levels and adverse pregnancy outcome

Design: Retrospective analysis. Setting: East London Hospital. Subjects: 724 women who had maternal serum alphafetoprotein levels measured between 15 to 19 weeks gestation. Main outcome measure: The main outcome measures were defined as any case of preeclampsia, small-for-gestational age (SGA) birth- weight th centile, placental abruption, stillbirth or early neonatal death. Methods: Women with MSAFP > 2.0 Multiples of Median (MoM) were classified as screen positive. Results: 41 (5.7%) women developed preeclampsia. Women with MSAFP > 2.0 Multiples of the Median (MoM) were significantly more likely to develop preeclampsia (p th centile

Expression of alpha-fetoprotein messenger RNA in BEL-7404 human hepatoma cells and effect of L-4-oxalysine on the expression

AIM To investigate alpha-fetoprotein (AFP) mRNA expression in BEL-7404 human hepatoma cells and the effect of L-4-oxalysine (OXL) on the expression.METHODS BEl-7404 human hepatoma cells were maintained in RPMI 1640 media. Human AFP cDNA probe was labelled with digoxigenin-11-dUTP by the random primer labelling method. The expression of AFP mRNA in Bel-7404 cells was determined by an in situ hybridization technique with digoxigenin-labelled human AFP cDNA probe. The positive intensities of AFP mRNA in cells were analyzed by microspectrophotometer and expressed as absorbance at 470nm. For the experiment with OXL, cells were incubated with various concentrations of the agent for 72h.RESULTS Essentially all the hepatoma cells contained AFP mRNA in the cytoplasm, although in various amounts. The specificity of the hybridization reaction was confirmed by control experiments in which the use of RNase-treated BEL-7404 cells, non-AFP-producing cells (HL-60 human leukemia cells) or a nonspecific cDNA probe resulted in negative hybridization. When the cells were treated with OXL (25, 50mg/L), the content of AFP mRNA in the cytoplasm was decreased with the inhibition percentages of 34.3% and 70.1%, respectively (P＜0.05).CONCLUSION AFP mRNA was expressed in BEL-7404 human hepatoma cells and OXL suppressed AFP mRNA expression in the cells.

Changes of serum alpha-fetoprotein and alpha-fetoprotein-L3 after hepatectomy for hepatocellular carcinoma: prognostic significance

BACKGROUND: Alpha-fetoprotein (AFP) is the most established tumor marker of hepatocellular carcinoma (HCC), but one of its limitations is non-specificity. Many studies have demonstrated that alpha-fetoprotein-L3 (AFP-L3) is more specific than AFP in the early diagnosis and prognosis of HCC. However, there is a lack of knowledge about the post-hepatectomy profiles of serum AFP and AFP-L3 values in HCC patients. To identify the profiles after surgical resection of HCC, we analyzed the correlation between the profiles and postoperative HCC recurrence or survival, and evaluated their utility in predicting postoperative therapeutic efficacy and prognosis. METHODS: From August 2003 to December 2004, 318 patients with positive serum AFP who had received surgical resections were enrolled in this study. Preoperative and postoperative serum AFP and AFP-L3 levels were measured simultaneously and regularly, and their postoperative profiles during a long term follow-up were recorded and summarized. RESULTS: A high ratio of AFP-L3 to total AFP was shown to correlate with pathologic features of aggressiveness. The overall 1-, 3-, and 5-year recurrence rates of the whole series were 28% 57%, and 84%, and the overall survival rates were 86%, 61% and 33%, respectively. The changes of serum AFP and AFP-L3 after hepatectomy for HCC were classified into 3 groups (group A: AFP-L3 undetectable; group B: AFP-L3 <10%; and group C: AFP-L3 >10%). Patients with positive postoperative AFP-L3had significantly earlier recurrence than those with negative results. The overall survival was significantly shorter in the positive groups than in the groups negative for postoperative AFP-L3.CONCLUSION: Post-hepatectomy changes in serum AFP and AFP-L3 levels occurred in three distinct patterns, which were closely correlated with HCC recurrence and patient survival with different prognostic values.

The intracellular mechanism of alpha-fetoprotein promoting the proliferation of NIH 3T3 cells

AIM: The existence and properties of alpha-fetoprotein (AFP) receptor on the surface of NIH 3T3 cells and the effects of AFP on cellular signal transduction pathway were investigated. METHODS: The effect of AFP on the proliferation of NIH 3T3 cells was measured by incorporation of 3H-TdR. Receptor-binding assay of 125I-AFP was performed to detect the properties of AFP receptor in NIH 3T3 cells. The influences of AFP on the [cAMP]i and the activities of protein kinase A (PKA) were determined. Western blot was used to detect the change of K-ras P21 protein expression. RESULTS: The proliferation of NIH 3T3 cells treated with 0-80 mg/L of AFP was significantly enhanced. The Scatchard analysis indicated that there were two classes of binding sites with KD of 2.722 x 10(-9)M (Bmax=12810 sites per cell) and 8.931 x 10(-8)M (Bmax=119700 sites per cell) respectively. In the presence of AFP (20 mg/L), the content of cAMP and activities of PKA were significantly elevated . The level of K-ras P21 protein was upregulated by AFP at the concentration of 20 mg/L. The monoclonal antibody against AFP could reverse the effects of AFP on the cAMP content, PKA activity and the expression of K-ras p21 gene. CONCLUSION: The effect of AFP on the cell proliferation was achieved by binding its receptor to trigger the signal transduction pathway of cAMP-PKA and alter the expression of K- ras p21 gene.

Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?

AIM: To identify the clinical outcomes of hepato-cellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence.METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group Ⅰ, AFP ≤ 20 ng/dL (n = 16); group Ⅱ, AFP 20-200 ng/dL (n = 24); and group Ⅲ, AFP ≥ 200 ng/dL (n = 29). Their preoperative clinical characteristics, accumulated recurrence rate, and recurrence-to-death survival rate were compared. Three patients, one in each group, underwentliver resection twice for primary and recurrent HCC. AFP immunohistochemistry of primary and recurrent HCC specimens were examined.RESULTS: In this study, 23% of patients demon-strated normal AFP levels at HCC recurrence. The AFP levels in these patients were initially high. There were no significant differences in clinical characteristics between the three groups except for the mean recur-rence interval (21.8 ± 14.6, 12.3 ± 7.7, 8.3 ± 6.6 mo, respectively, P < 0.001) and survival time (40.2 ± 19.9, 36.1 ± 22.4, 21.9 ± 22.0 mo, respectively, P = 0.013). Tumor size > 5 cm, total bilirubin > 1.2 mg/dL, vessel invasion, Child classification B, group Ⅲ, and recurrence interval < 12 mo, were risk factors for survival rate. Cox regression analysis was performed and vessel invasion, group Ⅲ, and recurrence interval were independent risk factors. The recurrence inter-val was significant longer in group Ⅰ (P < 0.001). The recurrence-to-death survival rate was significantly bet-ter in group Ⅱ (P = 0.016). AFP staining was strong in the primary HCC specimens and was reduced at recur-rence in group Ⅰ specimens.CONCLUSION: Patients in group Ⅰ with inconsistent AFP levels had a longer recurrence interval and worse recurrence-to-death survival rate than those in group Ⅱ. This clinical presentation may be caused by a delay in the detection of HCC recurrence.

Survival outcomes of liver transplantation for hepatocellular carcinoma in patients with normal, high and very high preoperative alpha-fetoprotein levels

AIM To investigate the impact of alpha-fetoprotein(AFP) on long-term recurrence rate and overall survival and we also aimed to define the level of AFP leading to a higher risk of disease recurrence and affecting patient survival.METHODS Data of adult patients who received liver transplant(LT) for hepatocellular carcinoma(HCC) at our hospital from January 2000 to December 2013 were reviewed. Reviewed data included demographic characteristics, preoperative AFP level, operative details, follow-up details, and survival outcomes. Patients were mostly listed for LT based on Milan or UCSF criteria. For the purpose of this study, normal AFP level was defined as AFP value < 10 ng/m L, high AFP level was defined as AFP value ≥ 10 to < 400 ng/m L, and very highAFP level was defined as AFP ≥ 400 ng/m L. The patients were divided into these 3 groups accordingly. Survival rates were plotted as Kaplan-Meier curves and compared by log-rank analysis. Continuous variables were expressed as median(interquartile range). Categorical variables were compared by Spearman's test. Discriminative analysis was used to define the lowest value of AFP that could affect the overall survival in study population. Statistical significance was defined by a P value of < 0.05.RESULTS Totally 250 adult patients underwent LT for HCC in the study period. Eight-four of them received deceaseddonor LT and 166 had living-donor LT. The patients were divided into 3 groups: Group A, AFP < 10 ng/m L(n = 83); Group B, AFP ≥ 10 to < 400 ng/m L(n = 131); Group C, AFP ≥ 400 ng/m L(n = 36). The commonest etiology was hepatitis-B-related cirrhosis. The Model for End-stage Liver Disease scores in these groups were similar(median, 13 vs 13 vs 12; P = 0.745). The time to operation in Group A was longer(median, 94 vs 31 vs 35 d; P = 0.001). The groups were similar in hospital mortality(P = 0.626) and postoperative complication(P = 0.702). Pathology of explants showed that the 3 groups had similar numbers of tumor nodules, but the tumors in Group C were larger(A: 2.5 cm, B: 3.0 cm, C: 4.0 cm; P = 0.003). Group C had a bigger proportion of patients who were beyond Milan criteria(P = 0.010). Poor differentiation and vascular permeation were also more common in this group(P = 0.017 and P = 0.003 respectively). It also had poorer 5-year survival(A: 85.5%, B: 82.4%, C: 66%; P = 0.029). The 5-year disease-free survival was 84.3% in Group A, 80.1% in Group B, and 61.1% in Group C. Receiver operating characteristic area under the curve for AFP in predicting tumor recurrence was 0.685. The selected cut-off value was 54 ng/m L for AFP(C-index 0.685; 95%CI: 0.592-0.779; sensitivity 0.595; specificity 0.687). On discriminative analysis, AFP value of 105 ng/m L was shown to affect the overall survival of the patients.CONCLUSION HCC patients with a high preoperative AFP level had inferior survival after LT. AFP level of 54 ng/m L was associated with disease recurrence, and AFP level of 105 ng/m L was found to be the cut-off value for overall survival difference.

Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma

AIM:To explore the relationship between α-fetoprotein(AFP) and various clinicopathological variables and different staging system of hepatocellular carcinoma(HCC) thoroughly.METHODS:A retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and December 2009 in West China Hospital was enrolled in our study.The association of serum AFP values with the HCC clinicopathological features was analysed by univariate and multivariate analysis,such as status of hepatitis B virus(HBV) infection,tumor size,tumor number,vascular invasion and degree of tumor differentiation.Also,patients were divided into four groups at the time of enrollment according to different cutoff values for serum value of AFP(≤ 20 μg/L,21-400 μg/L,401-800 μg/L,and ≥ 801 μg/L),to compare the positive rate of patient among four groups stratified by various clinicopathological variables.And the correlation of different kinds of tumor staging systems,such as TNM,Barcelona Clinic Liver Cancer(BCLC) staging classification and China staging,were compared with the serum concentration of AFP.RESULTS:A total of 2304 HCC patients were enrolled in this study totally;the mean serum level of AFP was 555.3 ± 546.6 μg/L.AFP levels were within the normal range(< 20 μg/L) in 27.4%(n = 631) of all the cases.81.4%(n = 1875) patients were infected with HBV,and those patients had much higher serum AFP level compared with non-HBV infection ones(573.9 ± 547.7 μg/L vs 398.4 ± 522.3 μg/L,P < 0.001).The AFP level in tumors ≥ 10 cm(808.4 ± 529.2 μg/L) was significantly higher(P < 0.001) than those with tumor size 5-10 cm(499.5 ± 536.4 μg/L) and with tumor size ≤ 5 cm(444.9 ± 514.2 μg/L).AFP levels increased significantly in patients with vascular invasion(694.1 ± 546.9 μg/L vs 502.1 ± 543.1 μg/L,P < 0.001).Patients with low tumor cell differentiation(559.2 ± 545.7 μg/L) had the significantly(P = 0.007) highest AFP level compared with high differentiation(207.3 ± 420.8 μg/L) and intermediate differentiation(527.9 ± 538.4 μg/L).In the multiple variables analysis,low tumor cell differentiation [OR 6.362,95%CI:2.891-15.382,P = 0.006] and tumor size(≥ 10 cm)(OR 5.215,95%CI:1.426-13.151,P = 0.012) were independent predictors of elevated AFP concentrations(AFP > 400 μg/L).Serum AFP levels differed significantly(P < 0.001) in the D stage of BCLC(625.7 ± 529.8 μg/L) compared with stage A(506.2 ± 537.4 μg/L) and B(590.1 ± 551.1 μg/L).CONCLUSION:HCC differentiation,size and vascular invasion have strong relationships with AFP,poor differentiation and HCC size ≥ 10 cm are independent predictors of elevated AFP.BCLC shows better relationship with

Assessment of the correlation between serum prolidase and alpha-fetoprotein levels in patients with hepatocellular carcinoma

AIM: To determine the predictive value of increased prolidase activity that reflects increased collagen turnover in patients with hepatocellular carcinoma(HCC).METHODS: Sixty-eight patients with HCC(mean age of 69.1 ± 10.1), 31 cirrhosis patients(mean age of59.3 ± 6.3) and 33 healthy volunteers(mean age of51.4 ± 12.6) were enrolled in this study. Univariate and multivariate analysis were used to evaluate the association of serum α-fetoprotein(AFP) values with HCC clinicopathological features, such as tumor size,number and presence of vascular and macrovascular invasion. The patients with HCC were divided into groups according to tumor size, number and presence of vascular invasion(diameters; ≤ 3 cm, 3-5 cmand ≥ 5 cm, number; 1, 2 and ≥ 3, macrovascular invasion; yes/no). Barcelona-clinic liver cancer(BCLC)criteria were used to stage HCC patients. Serum samples for measurement of prolidase and alphafetoprotein levels were kept at-80 ℃ until use.Prolidase levels were measured spectrophotometrically and AFP concentrations were determined by a chemiluminescence immunometric commercial diagnostic assay.RESULTS: In patients with HCC, prolidase and AFP values were evaluated according to tumor size, number,presence of macrovascular invasion and BCLC staging classification. Prolidase values were significantly higher in patients with HCC compared with controls(P <0.001). Prolidase levels were significantly associated with tumor size and number(P < 0.001, P = 0.002,respectively). Prolidase levels also differed in patients in terms of BCLC staging classification(P < 0.001).Furthermore the prolidase levels in HCC patients showed a significant difference compared with patients with cirrhosis(P < 0.001). In HCC patients grouped according to tumor size, number and BCLC staging classification, AFP values differed separately(P = 0.032,P = 0.038, P = 0.015, respectively). In patients with HCC, there was a significant correlation(r = 0.616; P< 0.001) between prolidase and AFP values in terms of tumor size, number and BCLC staging classification,whereas the presence of macrovascular invasion did not show a positive association with serum prolidase and AFP levels.CONCLUSION: Considering the levels of both serum prolidase and AFP could contribute to the early diagnosing of hepatocellular carcinoma.

Alpha-fetoprotein specific CD4 and CD8 T cell responses in patients with hepatocellular carcinoma

The presence of CD8 T cell responses to tumor associated antigens have been reported in patients with different malignancies. However, there is very little inf ormation on a comparable CD8 and CD4 T cell response to a tumor antigen in liver cancer patients. Here, we re-examine the kinetic and the pattern of T helper 1 and cytotoxic T lymphocyte responses to alpha-fetoprotein (AFP),a tumor rejection antigen in hepatocellular carcinoma (HCC). Then, we discuss the possibility of using AFP-based immunotherapy in combination with necrotizing treatments in HCC patients.

Prognostic role of alpha-fetoprotein response after hepatocellular carcinoma resection

AIM To investigate whether the change in pre-/post-operation serum alpha-fetoprotein(AFP) levels is a predictive factor for hepatocellular carcinoma(HCC) outcomes.METHODS We retrospectively analyzed 334 HCC patients who underwent hepatic resection at our hospital between January 2006 and December 2016. The patients were classified into three groups according to their change in serum AFP levels:(1) the normal group, pre-AFP ≤ 20 ng/m L and post-AFP ≤ 20 ng/m L;(2) the response group, pre-AFP > 20 ng/m L and post-AFP decrease of ≥ 50% of pre-AFP; and(3) the non-response group, pre-AFP level > 20 ng/m L and post-AFP decrease of < 50% or higher than pre-AFP level, or any pre-AFP level < 20 ng/m L but post-AFP >20 ng/m L RESULTS Univariate and multivariate analyses revealed thatmultiple tumors [hazard ratio(HR): 1.646, 95%CI: 1.15-2.35, P < 0.05], microvascular invasion(m VI)(HR: 1.573, 95%CI: 1.05-2.35, P < 0.05), and the nonresponse group(HR: 2.425, 95% CI: 1.42-4.13, P < 0.05) were significant independent risk factors for recurrencefree survival. Similarly, multiple tumors(HR: 1.99, 95%CI: 1.12-3.52, P < 0.05), m VI(HR: 3.24, 95%CI: 1.77-5.90, P < 0.05), and the non-response group(HR: 3.62, 95%CI: 1.59-8.21, P < 0.05) were also significant independent risk factors for overall survival. The nonresponse group had significantly lower overall survival rates and recurrence-free survival rates than both the normal group and the response group(P < 0.05). Thus, patients with no response regarding post-surgery AFP levels were associated with poor outcomes.CONCLUSION Serum AFP responses are significant prognostic factors for the surgical outcomes of HCC patients, suggesting post-resection AFP levels can direct the management of HCC patients.