Thrombocytopenia in Relation to Tumor Size in Patients with Hepatocellular Carcinoma
Thrombocytopenia in Relation to Tumor Size in Patients with Hepatocellular Carcinoma
复制标题
DOI：
10.1159/000342431
复制
发表时间：
2012-01-01
期刊：
影响因子：
3.5
通讯作者：
Pancoska, Petr
中科院分区：
文献类型：
--
作者：
Carr, Brian I.;Guerra, Vito;Pancoska, Petr
背景：诊断时肝细胞癌（HCC）的大小在治疗中很重要。如果没有筛查程序，诊断时的肿瘤大小是不均匀的。目的：探讨与肿瘤大小相关的临床参数。研究方法：使用前瞻性收集的数据，从1,100例活检证实的HCC队列中，在没有筛选的情况下，肿瘤大小进行了排序和切除，并比较了肿瘤和血液参数的结果。结果：tercile在门静脉高压症和血小板减少症方面有显著差异，在肿瘤较小的tercile I患者中，出现率较高。伴有较大HCC的Tercile III患者血清甲胎蛋白（AFP）、γ-谷氨酰转肽酶（GGTP）和碱性磷酸酶（ALKP）水平最高，门静脉（PV）血栓形成最多。根据AFP对第三类I患者进行亚分类，发现血清AFP高的患者肿瘤结节数量增加，PV血栓形成更多，胆红素、ALKP和GGTP水平更高，生存期更短。结论：肿瘤较小的tercile I患者比肿瘤较大的患者更易发生晚期门静脉高压伴血小板减少。与AFP水平较低的患者相比，AFP水平较高的Tercile I患者的PV血栓形成更频繁，生存率更差。血清GGTP和ALKP水平升高似乎与更具侵袭性的HCC表型相关。这些不同的模式表明不止一种HCC途径。版权所有（c）2012 S. Karger AG，巴塞尔
Background: Hepatocellular carcinoma (HCC) size at diagnosis is important in management. Without screening programs, tumor size at diagnosis is heterogeneous. Aims: To examine the clinical parameters related to tumor size. Methods: Using prospectively collected data from a 1,100-patient biopsy-proven HCC cohort presenting in the absence of screening, tumor sizes were ordered and trichotomized and the resulting terciles were compared for tumor and blood parameters. Results:The terciles were significantly different with respect to portal hypertension and thrombocytopenia, which were present in a higher percent of tercile I patients with smaller tumors. Tercile III patients with larger HCCs had the highest serum alpha-fetoprotein (AFP), gamma-glutamyl transpeptidase (GGTP), and alkaline phosphatase (ALKP) levels and the most portal vein (PV) thrombosis. Subclassification of tercile I patients by AFP showed that patients with high serum AFP had increased numbers of tumor nodules, more PV thrombosis, higher bilirubin, ALKP, and GGTP levels, and shorter survival. Conclusions: Smaller-tumor tercile I patients had more advanced portal hypertension with thrombocytopenia than did larger-tumor patients. Tercile I patients with higher AFP levels had more frequent PV thrombosis and worse survival than those with lower AFP levels. Elevated serum GGTP and ALKP levels appear to be associated with a more aggressive HCC phenotype. These differing patterns suggest more than one HCC pathway. Copyright (c) 2012 S. Karger AG, Basel