目的探讨不同血清肿瘤标志物在乙肝肝硬化人群中预测和诊断肝癌的临床价值。方法分析99例乙肝肝硬化患者、99例乙肝肝硬化合并原发性肝癌患者的临床资料,分别检测血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和白介素6(IL-6)含量,并计算A...目的探讨不同血清肿瘤标志物在乙肝肝硬化人群中预测和诊断肝癌的临床价值。方法分析99例乙肝肝硬化患者、99例乙肝肝硬化合并原发性肝癌患者的临床资料,分别检测血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和白介素6(IL-6)含量,并计算AFP-L3%(AFP-L3/AFP),比较两组间各血清肿瘤标志物表达水平差异,并计算各血清肿瘤标志物诊断肝癌的敏感度及特异性。结果乙肝肝硬化组与乙肝肝硬化合并肝癌组之间AFP[3.2(2.1,8.5)ng/ml vs 14.1(3.9,128.3)ng/ml]、AFP-L3[0.2(0.1,0.5)ng/ml vs 0.8(0.2,13.8)ng/ml]、AFP-L3%[5.0%(5.0%,5.0%)vs 5.0%(5.0%,11.7%)]、IL-6[8.7(6.3,11.4)pg/ml vs 13.5(10.7,16.5)pg/ml],差异均有统计学意义(P<0.05)。AFP在乙肝肝硬化人群诊断肝癌的敏感度为43.9%,特异性为84.8%;AFP-L3敏感度为48.1%,特异性为83.8%;AFP-L3%敏感度为29.3%,特异性为97.5%;IL-6敏感度为98.9%,特异性为34.3%。结论血清肿瘤标志物AFP、AFP-L3、AFP-L3%均能有效用于乙肝肝硬化人群预测和诊断肝癌,AFP-L3%更具优势;IL-6敏感度虽高,但特异性低,不能有效用于肝癌的诊断。展开更多
Background:Hepatocellular carcinoma(HCC)is the most common cause of cancer-related death in Saudi Arabia.Our study aimed to investigate the patterns of HCC and the effect of TNM staging,Alfa-fetoprotein(AFP),and Child...Background:Hepatocellular carcinoma(HCC)is the most common cause of cancer-related death in Saudi Arabia.Our study aimed to investigate the patterns of HCC and the effect of TNM staging,Alfa-fetoprotein(AFP),and Child-Turcotte Pugh(CTP)on patients’overall survival(OS).Methods:A retrospective analysis was conducted on 43 HCC patients at a single oncology center in Saudi Arabia from 2015 to 2020.All patients had to fulfill one of the following criteria:(a)a liver lesion reported as definitive HCC on dynamic imaging and/or(b)a biopsy-confirmed diagnosis.Results:The mean patient age of all HCC cases was 66.8 with a male-to-female ratio of 3.3:1.All patients were stratified into two groups:viral HCC(n=22,51%)and non-viral HCC(n=21,49%).Among viral-HCC patients,55%were due to HBV and 45%due to HCV.Cirrhosis was diagnosed in 79%of cases.Age and sex did not significantly statistically differ in OS among viral and non-viral HCC patients(p-value>0.05).About 65%of patients had tumor size>5 cm during the diagnosis,with a significant statistical difference in OS(p-value=0.027).AFP was>400 ng/ml in 45%of the patients.There was a statistically significant difference in the OS in terms of AFP levels(p-value=0.021).A statistically significant difference was also observed between the CTP score and OS(p-value=0.02).CTP class B had the longest survival.BSC was the most common treatment provided to HCC patients followed by sorafenib therapy.There was a significant statistical difference in OS among viral and non-viral HCC patients(p-value=0.008).Conclusions:The most common predictors for OS were the underlying cause of HCC,AFP,and tumor size.Being having non-viral etiology,a tumor size>5 cm,an AFP>400 ng/mL,and a CTP score class C were all negatively associated with OS.展开更多
背景肝脏肿瘤性质的无创鉴别是当前临床面临的难题.超声造影(contrast-enhanced ultrasounds,CEUS)和血清甲胎蛋白(alpha-fetoprotein,AFP)/总胆汁酸(total bile acid,TBA)各具优势,但联合诊断价值尚不明确,本研究假设二者联合可提高肝...背景肝脏肿瘤性质的无创鉴别是当前临床面临的难题.超声造影(contrast-enhanced ultrasounds,CEUS)和血清甲胎蛋白(alpha-fetoprotein,AFP)/总胆汁酸(total bile acid,TBA)各具优势,但联合诊断价值尚不明确,本研究假设二者联合可提高肝脏肿瘤无创鉴别诊断效能,并与病理结果一致.目的研究CEUS联合血清AFP/TBA鉴别肝血管瘤、原发性肝癌及肝转移瘤与病理活检的一致性.方法选取2023-07/2025-03杭州市临安区第四人民医院收治的291例肝脏肿瘤患者作为研究对象,建立CEUS联合血清AFP/TBA的鉴别诊断模型,其中经组织病理确诊恶性198例(原发性肝癌135例,肝转移瘤63例)为恶性组,良性93例(肝血管瘤)为良性组.另选本中心2025-04/2025-06,124例肝脏肿瘤(组织病理学提示恶性88例,良性36例)患者作为外部验证数据.比较2组常规超声表现、CEUS结果及血清AFP/TB,构建Logistic回归模型分析恶性病变的影响因素,使用受试者工作特征(receiver operating characteristic,ROC)曲线分析CEUS、血清AFP/TBA单独及联合应用在病灶性质鉴别诊断中的价值,并采用ROC曲线、一致性分析对联合诊断效能进行内、外部评价.结果恶性组形态不规则占比、边界不清晰占比、内部回声不均匀占比、病灶及周围血流信号Ⅱ级+Ⅲ级占比、增强速率及血清AFP/TBA分别为32.83%、46.46%、60.10%、91.92%、(0.85±0.19)、(6.07±2.02),显著高于良性组20.43%、31.18%、24.73%、19.33%、(0.57±0.16)、(1.64±0.53),50%倾斜率、达峰时间分别为(0.59±0.12)、(35.40±7.62),显著低于良性组(0.80±0.24)、(44.93±10.51),差异均有统计学意义(P<0.05);Logistic回归模型分析显示,形态不规则、边界不清晰、内部回声不均匀、病灶及周围血流信号Ⅱ级+Ⅲ级、增强速率、血清AFP/TBA是恶性病变的危险因素,50%倾斜率、达峰时间是其保护因素(P<0.05);ROC曲线分析显示,CEUS联合血清AFP/TBA鉴别诊断病灶性质的曲线下面积为0.928,内、外部评价结果显示,净改善了86.50%的分类正确率及对病灶性质的区分能力(均P<0.001);一致性分析发现,CEUS与血清AFP/TBA鉴别诊断结果与病理活检结果一致性好(Kappa=0.819)(P<0.001).结论CEUS联合血清AFP/TBA对肝血管瘤、原发性肝癌及肝转移瘤具有一定鉴别诊断价值,且与病理活检结果具有良好一致性,可为临床无创鉴别诊断肝脏肿瘤性质提供参考,并可指导后续临床决策.展开更多
文摘目的探讨不同血清肿瘤标志物在乙肝肝硬化人群中预测和诊断肝癌的临床价值。方法分析99例乙肝肝硬化患者、99例乙肝肝硬化合并原发性肝癌患者的临床资料,分别检测血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和白介素6(IL-6)含量,并计算AFP-L3%(AFP-L3/AFP),比较两组间各血清肿瘤标志物表达水平差异,并计算各血清肿瘤标志物诊断肝癌的敏感度及特异性。结果乙肝肝硬化组与乙肝肝硬化合并肝癌组之间AFP[3.2(2.1,8.5)ng/ml vs 14.1(3.9,128.3)ng/ml]、AFP-L3[0.2(0.1,0.5)ng/ml vs 0.8(0.2,13.8)ng/ml]、AFP-L3%[5.0%(5.0%,5.0%)vs 5.0%(5.0%,11.7%)]、IL-6[8.7(6.3,11.4)pg/ml vs 13.5(10.7,16.5)pg/ml],差异均有统计学意义(P<0.05)。AFP在乙肝肝硬化人群诊断肝癌的敏感度为43.9%,特异性为84.8%;AFP-L3敏感度为48.1%,特异性为83.8%;AFP-L3%敏感度为29.3%,特异性为97.5%;IL-6敏感度为98.9%,特异性为34.3%。结论血清肿瘤标志物AFP、AFP-L3、AFP-L3%均能有效用于乙肝肝硬化人群预测和诊断肝癌,AFP-L3%更具优势;IL-6敏感度虽高,但特异性低,不能有效用于肝癌的诊断。
文摘Background:Hepatocellular carcinoma(HCC)is the most common cause of cancer-related death in Saudi Arabia.Our study aimed to investigate the patterns of HCC and the effect of TNM staging,Alfa-fetoprotein(AFP),and Child-Turcotte Pugh(CTP)on patients’overall survival(OS).Methods:A retrospective analysis was conducted on 43 HCC patients at a single oncology center in Saudi Arabia from 2015 to 2020.All patients had to fulfill one of the following criteria:(a)a liver lesion reported as definitive HCC on dynamic imaging and/or(b)a biopsy-confirmed diagnosis.Results:The mean patient age of all HCC cases was 66.8 with a male-to-female ratio of 3.3:1.All patients were stratified into two groups:viral HCC(n=22,51%)and non-viral HCC(n=21,49%).Among viral-HCC patients,55%were due to HBV and 45%due to HCV.Cirrhosis was diagnosed in 79%of cases.Age and sex did not significantly statistically differ in OS among viral and non-viral HCC patients(p-value>0.05).About 65%of patients had tumor size>5 cm during the diagnosis,with a significant statistical difference in OS(p-value=0.027).AFP was>400 ng/ml in 45%of the patients.There was a statistically significant difference in the OS in terms of AFP levels(p-value=0.021).A statistically significant difference was also observed between the CTP score and OS(p-value=0.02).CTP class B had the longest survival.BSC was the most common treatment provided to HCC patients followed by sorafenib therapy.There was a significant statistical difference in OS among viral and non-viral HCC patients(p-value=0.008).Conclusions:The most common predictors for OS were the underlying cause of HCC,AFP,and tumor size.Being having non-viral etiology,a tumor size>5 cm,an AFP>400 ng/mL,and a CTP score class C were all negatively associated with OS.
