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目的 :研究原发性肝癌患者手术和经导管肝动脉栓塞化疗 (TAE)术前后外周血中微转移变化情况 ,并评价AFPmRNA的预后诊断价值。方法 :应用巢式RT PCR方法 ,检测 2 2例和 32例肝癌患者手术和TAE术前后外周血中AFPmRNA的表达 ,并对其预后进行随访观察。结果 :2 2例手术患者术前 7例 ( 31.8% )AFPmRNA阳性 ,术后有 4例转阴 ;而术前AFPmRNA阴性的病例中有 1例术后转为阳性。随访观察 8例于术前或术后AFPmRNA阳性患者中有 4例发生肝内复发 ,复发率 5 0 .0 % ;而 14例于术前或术后AFPmRNA均阴性患者中出现肝内转移者 2例 ( 14 .3% ) ,差异明显 (P <0 .0 5 )。随访期间未发现患者术后发生远处转移。 32例TAE患者术前AFPmRNA阳性 2 1例 ,阳性率6 5 .6 % ;术后AFPmRNA阳性 2 3例 ,阳性率为 71.9%。其中 2 1例术前阳性者依然全部阳性 ,未发现有转阴者 ;11例阴性患者中有 2例转为阳性。随访观察发现AFPmRNA阳性患者肝内、肝外转移发生率和AFPmRNA阴性患者差异显著 (P <0 .0 1)。结论 :手术切除原发灶可消除播散肝癌细胞的来源。同时 ,手术亦可能激活癌细胞而发生血道播散。TAE可能促使原发性肝癌发生血道播散。检测肝癌患者外周血中的AFPmRNA ,是一种灵敏的预后诊断方法。
Objective: To study the changes of peripheral blood micrometastases in patients with primary hepatic carcinoma before and after transcatheter arterial chemoembolization (TAE) and evaluate the prognostic value of AFP mRNA. Methods: Nested RT-PCR was used to detect the expression of AFPmRNA in peripheral blood before and after surgery and TAE in 22 patients with hepatocellular carcinoma (HCC) and 32 patients with HCC. The prognosis was followed up. Results: AFP mRNA was positive in 7 cases (31.8%) of 2 2 cases before surgery, 4 cases were negative after surgery. One case of preoperative AFP mRNA was positive after operation. Follow-up observation in 8 cases of preoperative or postoperative AFPmRNA positive patients, 4 cases of intrahepatic recurrent relapse rate of 50%; and 14 cases of AFPmRNA in patients with preoperative or postoperative intrahepatic metastasis 2 Cases (14.3%), the difference was significant (P <0. 05). No follow-up found in patients with distant metastasis. 32 cases of TAE patients preoperative AFP mRNA positive 21 cases, the positive rate of 65.6%; postoperative AFP mRNA positive 23 cases, the positive rate was 71.9%. 21 of them were still positive before surgery and no negative ones were found. 2 of 11 negative patients turned positive. Follow-up observation found AFPmRNA positive patients with intrahepatic and extrahepatic metastases and AFPmRNA negative patients were significantly different (P <0.01). Conclusion: Surgical removal of primary tumor can eliminate the source of disseminated hepatocellular carcinoma cells. At the same time, surgery may also activate cancer cells and spread of bloodstream. TAE may promote the occurrence of primary hepatic hematogenous disseminated. Detection of AFP mRNA in the peripheral blood of patients with hepatocellular carcinoma is a sensitive prognostic method.