外周血甲胎蛋白mRNA和黑色素瘤抗原-1mRNA联合表达与肝细胞癌术后复发转移的关系  

Peripheral MAGE-1 mRNA and AFP mRNA determinations in patients with hepatocelluar carcinoma： early prediction of postoperative recurrence or metastasis

作　　者：张毓青[1] 宋天强[1] 孟令新[1] 郭仁德[1] 冯靖[2] 李强[1] 

机构地区：[1]天津医科大学附属肿瘤医院肝胆科,300060 [2]天津医科大学附属总医院内科

出　　处：《中华普通外科杂志》2007年第6期449-452,共4页Chinese Journal of General Surgery

摘　　要：目的 探讨外周血甲胎蛋白（AFP）mRNA和黑色素瘤抗原-1（MAGE-1）mRNA联合表达在早期发现肝细胞癌患者术后复发或转移的意义。方法 应用巢式逆转录聚合酶链反应技术分别在术前、术后1周和2个月检测142例行根治性切除的肝细胞癌患者外周血中AFPmRNA和MAGE-1mRNA的表达，随访时间从术后至22个月，中位随访时间为15．5个月。结果 外周血中MAGE-1mRNA和／或AFPmRNA的阳性率和肿瘤的病理分期呈正相关：肿瘤病期越晚，外周血中肝癌细胞的检出率越高（χ^2=17．873，P〈0．01）。AFPmRNA和Mage-1mRNA阳性率均与癌结节数目、门静脉癌栓、肝内、外转移等临床参数显著相关（χ^2=11．510，χ^2=15、149，χ^2=11．653，χ^2=6．805，均P〈0.01），而与肝癌分化程度、肿瘤直径等无相关性（χ^2=1．513，χ^2=1．343，均P〉0．05）。术后55例患者出现复发或转移，其中38例患者外周血MAGE-1mRNA和／或AFPmRNA持续阳性，14例由术前阴性转为阳性。而62例由术前阳性转为术后阴性者，随访中未见复发或转移。术后外周血AFPmRNA和／或MAGE-1mRNA阳性组中，有88．1％（52／59）的患者出现复发或转移，而阴性组中复发或转移者仅占3．6％（3／83），两组比较，差异有统计学意义（χ^22=103．817，P=0．000）。结论 联合检测外周血MAGE-1和AFPmRNA的表达可能早期发现肝细胞癌术后复发或转移，可以作为评估预后的指标。Objective To evaluate a combination determination of peripheral MAGE-1 and AFP mRNA as a predictor of postoperative recurrence or metastasis in patients of hepatocellular carcinoma （HCC）. Methods Nested RT-PCR was used to detect peripheral MAGE-1 mRNA and AFP mRNA in HCC patients undergoing radical hepatectomy preoperatively, and one week and 2 months postoperatively. All patients were followed up from 5 to 22 months with a median follow-up period of 15.5 months. Result The expression of MAGE-1 and/or AFP mRNA in peripheral blood was proportionally correlated to the pathological stages of HCC. The more advanced ＇was the stage of HCC, the higher was the detectable rate of micro-metastasis of tumor cells in the peripheral blood （ χ^2 = 17. 873, P 〈 0.01 ）. Postoperative tumor recurrence and/or metastasis was found in 55 of the 142 HCC patients. The positive rates of AFP mRNA and/or MAGE-lmRNA in patients with multiple tumor foci （47/52, 90. 4% ）, with intrahepatic metastasis （40/43, 93.0% ） and with portal vein thrombosis （33/33, 100. 0% ） were significantly higher than those in patients with solitary foci （58/90, 64. 4% ）, without intrahepatic metastasis （65/99, 65.7% ） and without portal vein thrombosis （72/109, 66. 1% ） （ χ^2 = 11. 510, χ^2 = 15. 149, χ^2 = 11. 653, χ^2 = 6. 805, all P 〈0. 01 ）. The frequency of AFP and MAGE-1 transcripts detected in PBMC is in strong correlation with clinical severity. The expression of AFP or MAGE-1 transcripts did not correlate with any of the other parameters, such as the degree of tumor differentiation, tumor diameter, etc （χ^2 = 1. 513, χ^2 = 1. 343, all P 〉 0. 05）. Among those 55 patients with tumor recurrence or metastasis, 38 had persistent expression of MAGE-1mRNA and/or AFP mRNA in peripheral blood and 14 had MAGE-1 mRNA or AFP mRNA turning from negative to positive, in contrast to no recurrence or metastasis in the 62 patients in which the positive preoperative MAGE-1 and/or AFP mRNA expressions turned to negativ

关 键 词：癌 肝细胞 肿瘤转移 黑色素瘤 抗原 甲胎蛋白类 

分 类 号：R686[医药卫生—骨科学]