The most comprehensive summary, the 5 applications of a fetal protein in the diagnosis and treatment of liver cancer

Primary hepatic liver cancer (primaryicchepatarcinoma, PHC) is one of the common malignant tumors in China, according to different pathological types can be divided into three categories, namely, hepatocellular cancer (HCC), hepatic bile duct cancer (ICC) and HCC-ICC hybrid type, of which HCC accounts for 85% to 90% or moreThe top five are the fourth most common malignant tumors in China (lung, stomach, colorectal, liver and female breast cancer)Table 1Estimates of the incidence of the top 10 malignant tumors in China in 2015Journal of.2019.41 (1): 19-28high-risk populations need to pay attention to screening prevention of liver cancer, such as viral hepatitis (HBV and HCV) infection, non-alcoholic fatty hepatitis, long-term alcoholism, eating foods contaminated with aflatoxin, cirrhosis, liver cancer family history, etcthe detection of serum tumor markerscan be one of the main methods for early screening of liver cancer and post-treatment efficacy assessmentThe guidelines for the diagnosis and treatment of primary liver cancer identify the serum-foetoprotein (ALPHA-foetoprotein, AFP) as a common and important index for the diagnosis of liver cancer and efficacy testingthe whole name of the fetal globulin, belongs to a glycoprotein, the molecular weight is about 70KD, mainly by the femactal sac and liver synthesis secretionIn fetuses around 30 weeks of pregnancy, serum AFP concentration reaches the highest value, will slowly decrease later, at birth to 40 ng/mL, the infant's body at the age of age of AFP concentration is close to normal human level (20 ng/mL)When liver lesions cause liver cell damage, liver cells re-produce AFP, the greater the damage to the liver cells, the higher the AFP concentrationSerum AFP is 400ng/mL, which is highly indicative of liver cancer after the exclusion of pregnancy, chronic or active liver disease, reproductive adenology embryo-derived tumors, and gastrointestinal tumors1The AFP level can reflect the stage of liver cancer development Dou-Sheng Bai et al published articles in NATURE, in the United States SEER database counted 78743 registered HCC patients, of which 38820 cases of HCC patients have AFP information, analysis of AFP level is tumor pathological classification, disease progression, patient survival rate related to independent risk factors Ganyu and others counted 62 cases of primary liver cancer, and found that the level of AFP expression in liver cancer tissue and the level of AFP expression in serum were positively correlated, and the level of AFP expression in serum was related to the size of PHC tumor Early winter sister and other statistics 40 cases of primary liver cancer patients, compared with 40 health check-ups, found that primary liver cancer patients WITH the AFP level increased with TNM staging, tumor patients Phase III, IV AFP detection rate is significantly higher than Stage I and II serum AFP half-life is about 4 days, and AFP levels usually drop rapidly after liver removal If the AFP level is abnormal after surgery or the AFP level increases, it may indicate cancerous metastasis or the possibility of other tumors 2 Separately measured AFP s 200ng/mL can be used as a positive indicator of liver cancer, joint B super-test inglision of AFP 20ng/mL can be used as a positive indicator
Tianzhou and others counted 2212 cases of primary liver cancer diagnosed between 2007 and 2017 at Huai'an First Hospital affiliated with Nanjing Medical University Eight patients with non-primary liver cancer were compared, and the study found that the COMBINATION of sensitivity and specificity was highest at 201 to 250 ng/mL, the largest area under the ROC curve (0.8964), and the optimal threshold for clinical diagnosis of primary liver cancer was 200 ng/mL The sensitivity of AFP concentration greater than 20ng/mL in combination with B super-diagnosed primary liver cancer (95.35%), and AFP can be used as a positive index of 20ng/mL when screening people at high risk of combined primary liver cancer with AFP testing Figure 1 AFP diagnosed HCC's ROC curve 3 By detecting THE AFP level, the screening of liver cancer patients can guide the size of liver excision Jin-Chiao Lee et al counted 534 patients with liver cancer liver resection, analyzed the relationship between THE AFP level and surgical cut, and the surgery enough cut to reduce tumor recurrence At serum AFP level of 15ng/mL, the surgical cut has no effect on disease-free survival, when the AFP level is 15 to 200 ng/mL, the surgical cut will increase the five-year disease-free survival rate from 24.6% to 38.7%, and when the AFP level is 200ng/mL, the surgical cut-off rate of 1cm will increase the five-year disease-free survival rate from 33.94% to 33.94% Table 2 Survival rate based on preoperative AFP levels and cut-edge judgment
4.AFP testing also helps guide the treatment of advanced liver cancer drugs (sorafenib) the significance of the detection of AFP levels may be limited to monitoring of treated patients, AFP testing may also contribute to follow-up to the treatment of advanced liver cancer medications Solafenib is a broad-spectrum kinase inhibitor that has been shown in two Phase III clinical trials to improve the overall survival rate of patients with advanced liver cancer Research by Nicola Personeni et al who assessed the role of atherocostin in the treatment of advanced liver cancer in sorafenib found that a 20 percent decrease in serum AFP levels in the body eight weeks after starting sorafenib treatment was associated with a better overall survival rate In this case, imaging is unpredictable The early rise of AFP indicates a progressive disease and a lower survival rate, and therefore may also be an effective tumor marker for treatment with sorafenib in patients with advanced liver cancer Based on these observations, AFP can be considered one of the few biomarkers that reflect the efficacy of sorafenib in the treatment of liver cancer 5 AFP and other tumor markers jointly detect and diagnose liver cancer there are many tumor markers that currently reflect liver cancer, in addition to AFP, there are abnormal clotting enzyme (PIVKA-II), cancer embryo antigen (CEA), sugar antigen 125 (CA125) and sugar antigen 19-9 (CA19-9) and so on studies have shown that AFP levels did not rise in some liver cancer patients, in which case AFP cannot be used for liver cancer screening, which requires comprehensive determination in combination with other tumor markers The joint detection of various tumor markers can make up for the defects of single tumor marker detection, such as differences in the expression of various tumor markers due to different pathological characteristics of liver cancer, and the sensitivity of detection can be increased statistically Kong Yinbo and others studied 104 phC patients in Linyi City People's Hospital in Yunnan Province between January and December 2017, and analyzed the significance of different combinations (i.e., AFP-CA125, AFP-CA19-9, AFP-CA125-CA19-9) compared with 104 non-PHC patients in the same period of time It is found that the combined detection of three tumor markers, AFP-CA125-CA19-9, can improve the accuracy of diagnosis and reduce missed diagnosis Figure 2 Roc curve of serum AFP, CA125, CA19-9 and its different combinations of joint testing Gao Pengfei and others studied 72 cases of primary liver cancer between January 2014 and January 2019 at Taihe County People's Hospital, 65 patients with benign liver disease as a healthy liver disease group, and 80 health examination patients as healthy The clinical significance of the combined testing of AFP, CEA, CA19-9, CA125 and CA15-3 was analyzed, and found that the combined detection of AFP, CEA, CA19-9, CA125 and CA15-3 could improve the sensitivity and specificity of primary liver cancer diagnosis, and had better diagnostic value for primary liver cancer Table 3 The diagnostic value of individual detection and joint detection of different tumor markers for primary liver cancer concluding AFP as an efficient tumor marker, can play an important role in the detection and diagnosis and treatment of liver cancer It has clear use value in many directions, such as diagnosis, surgical guidance, prognosis and evaluation of drug effects It can also be combined with other tumor markers to obtain higher detection sensitivity and specificity Diremedical Source: