Trends in Tumor Indices in Relation to Increased Hepatocellular Carcinoma Size: Evidence for Tumor Evolution as a Function of Growth
Trends in Tumor Indices in Relation to Increased Hepatocellular Carcinoma Size: Evidence for Tumor Evolution as a Function of Growth
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DOI：
10.1007/s12029-020-00530-9
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发表时间：
2020-10-02
影响因子：
1.6
通讯作者：
Yilmaz, S.
中科院分区：
文献类型：
--
作者：
Carr, Brian I.;Guerra, V.;Yilmaz, S.
背景HCC的预后在很大程度上取决于最大肿瘤直径（MTD）。目的探讨MTD < 2 ~ 8cm范围内肿瘤侵袭性的特征。方法回顾性分析一个大型HCC数据库中血清甲胎蛋白（AFP）的变化趋势，以及门静脉血栓形成（PVT）或肿瘤多灶性患者的百分比。结果血清AFP水平和PVT患者百分比均有显著升高趋势，p < 0.001。在这些趋势中，与特定MTD范围相关的AFP或PVT患者百分比的变化存在明确可识别的亚趋势。计算不同MTD范围内AFP或百分比PVT患者的增加倍数显示，与相关MTD增加相比，AFP或百分比PVT患者的增加更大。有趣的是，PVT百分比的增加主要与AFP无关。结论AFP和PVT随MTD的增加有明显的非线性变化。与MTD相比，肿瘤侵袭性因子增加了更大倍，这表明hcc可能随着大小的增加而改变为更具侵袭性的表型。因此，基线肝细胞癌活检可能在未来合理的肝细胞癌治疗中不足，重复的液体活检有可能跟踪肝细胞癌的演变，从而选择治疗方法。
Background The prognosis of HCC depends in large measure on maximum tumor diameter (MTD). Aims To examine characteristics of tumor aggressiveness over an MTD range of< 2 to 8 cm. Methods A large HCC database was examined retrospectively for trends in serum alpha-fetoprotein (AFP), and percent of patients with macroscopic portal vein thrombosis (PVT) or tumor multifocality. Results There was a significant trend to increased serum AFP levels and percent of patients with PVT, for each,p < 0.001. Within those trends, there were clearly identifiable sub-trends for variations of AFP or percent PVT patients, associated with specific MTD ranges. Calculation of the fold increase for either AFP or percent PVT patients over distinct MTD ranges showed a greater increase of AFP or percent PVT patients compared with the related MTD increase. Interestingly, the increase in percent PVT was mainly independent of AFP. Conclusions Patterns of AFP and PVT increase can be discerned with increasing MTD, which are nonlinear. The greater fold increase in tumor aggressiveness factors compared with MTD suggests that HCCs may change with increasing size to a more aggressive phenotype. Baseline HCC biopsies might therefore be insufficient in future rational HCC management, and repeated liquid biopsies have potential in following HCC evolution and thus choices of therapies.