Ultrasonography screening for hepatocellular carcinoma in Japanese patients with diabetes mellitus

BACKGROUND

Effective surveillance for hepatocellular carcinoma (HCC) in diabetes mellitus (DM) has not been established. We elucidated the risk factors for HCC in DM patients.

METHODS

From 2000 to 2014, 80 patients diagnosed with HCC for the first time who had concomittant DM but no other etiology of liver disease were enrolled as the DM-HCC group. From 2005 October to 2014, after introduction of the abdominal ultrasonography (US) report database, 2083 DM patients with no viral hepatitis, no known autoimmune hepatic diseases, and/or no evidence of alcohol abuse (>60 g/day) were enrolled as the DM-US group. Findings from the first US screening were evaluated. "Elderly" patients were defined as those aged >65 years. Clinical features of DM-HCC patients were evaluated and compared with those of DM-US patients.

RESULTS

In the DM-HCC group (54 men, 26 women), the mean (± SD age was 74.1 ± 8.5 years, and mean HbA1c and fibrosis-4 (FIB-4) index were 7.3 ± 1.3% and 4.50 ± 3.42, respectively. Mean tumor diameter was 5.7 ± 3.5 cm, there were 63/13/2/2 patients classified as Child-Pugh A/B/C/unknown, and 56/24 were single/multiple lesions. In the DM-US group, HCC was detected in three patients (0.14%; 0.3% of those classified as elderly). The mean age and FIB-4 index of these three patients (one man, two women) were 75.6 years (range 67-92 years) and 4.84 (range 2.87-6.98), respectively. Mean tumor diamter was 7.6 cm and there were one and two single and multiple lesions, respectively. In elderly DM-US patients with a high FIB-4 index (≥4), the rate of HCC detection was 5.0%.

CONCLUSIONS

Being elderly and having a high FIB-4 index are characteristic features of DM-HCC. Similar characteristics were noted for patients with HCC in the DM-US group. HCC surveillance with US is recommended for DM patients, especially those who are elderly (≥65 years) and have a high FIB-4 index.

[Research progress of miRNAs targeting GSK-3β in regulation of hepatocellular carcinoma invasion and metastasis]

Invasion and metastasis are key factors contributing to the high mortality rate of patients with hepatocellular carcinoma (HCC) involving a complex mechanism. In the invasion and metastasis of HCC, miRNAs can serve as either oncogenes or tumor suppressor genes to regulate the differentiation and proliferation of tumor cells being and play important roles in tumorigenesis, angiogenesis, invasion and metastasis. This review summarizes the recent progress in research of the molecular mechanisms by which miRNAs targeting GSK-3β regulate HCC invasion and metastasis and examines the roles of miRNAs in hepatocellular carcinoma cell proliferation, apoptosis, invasion, metastasis, and GSK-3β regulation.

血清胸苷激酶1在肝癌中表达升高和BCLC分期相关

目的

探讨血清胸苷激酶1(thymidine kinase 1, TK1)在肝癌患者中的表达水平、对肝癌诊断价值及其对预后的指导意义.

方法

采用免疫印迹增强化学发光法检测77例肝癌患者(肝癌组)、41例肝硬化患者(肝硬化组)和47例健康对照者(对照组)血清TK1水平, 对肝癌组患者随访观察2年, 以死亡为终点事件. 非正态分布的计量资料, 采用中位数和四分位数间距表示, 各组间比较采用非参数检验的Kruskal Wallis检验. 通过ROC曲线和ROC曲线下面积(area under curve, AUC)评价TK1对肝癌的诊断价值. 采用Kaplan-Meier法进行生存分析, Log Rank法进行差异性检验, 以P<0.05为差异有统计学意义.

结果

肝癌组患者血清TK1水平为1.85(0.94-3.755)pmol/L, 较肝硬化组的血清TK1水平0.90(0.56-3.13)pmol/L和对照组的血清TK1水平0.72(0.49-1.07)pmol/L明显升高(P<0.05), 肝硬化组和对照组之间TK1水平无差别. 血清TK1对肝癌有诊断价值, AUC为0.739(P<0.05), 诊断界值为1.105, 敏感性为0.714, 特异性为0.693. 血清TK1的水平和患者年龄、谷草转氨酶(aspartate transaminase, AST)、肝功能分级、BCLC分期、血管侵犯、肿瘤大小、肿瘤个数呈正相关(P<0.05). 血清TK1水平在BCLC分期(C+D)期患者高于BCLC(A+B)期患者(P<0.05).

结论

血清TK1在肝癌患者中升高, 可作为诊断肝癌的血清学标志物之一. TK1的水平和肝细胞癌(hepetocellular carcinoma, HCC)患者年龄、AST、肝功能分级、BCLC分期、血管侵犯、肿瘤大小、肿瘤个数正相关. TK1在BCLC(C+D)期患者高于BCLC(A+B)期肝癌患者, 对判断HCC患者的预后有一定指导意义.

[Expression of Wnt5b in patients with HBV-related hepatocellular carcinoma and its clinical significance]

OBJECTIVE

To investigate the expression of Wnt5b in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) tissues and its correlation with the clinicopathological parameters.

METHODS

Quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemical staining were employed to measure Wnt5b mRNA and protein expressions in two groups of HBV-related HCC patients (100 cases in each) selected from a cohort of 289 cases with HBV-related HCC using simple random sampling method. The correlation of Wnt5b expression with the clinicopathological parameters and the prognosis of HCC patients was analyzed.

RESULTS

Wnt5b mRNA expression was significantly higher in HCC tissues than that of adjacent noncancerous tissues in 65.0% (65/100) of the cases, and the positivity rate of Wnt5b protein was significantly higher in HCC tissues than that of adjacent noncancerous tissues (58.0% vs 22.0%, P<0.05). Wnt5b expression was significantly correlated with the tumor size (P<0.05), tumor number (P<0.01, only at the protein level), tumor differentiation (P<0.01, only at the protein level), TNM stage (P<0.05), BCLC stage (P<0.05), metastasis (P<0.05) and recurrence (P<0.01). The patients with up-regulated Wnt5b mRNA and protein had a shorter relapse-free survival (P<0.01).

CONCLUSION

s Up-regulated Wnt5b might contribute to the progression of HBV-related HCC and predicts a poor prognosis.

[Establishment and gene expression analysis of drug-resistant cell lines in hepatocellular carcinoma induced by sorafenib]

OBJECTIVE

To establish the drug-resistant cell lines of hepatocellular carcinoma (HCC) induced by sorafenib, and to screen out the high expression genes in drug-resistant cell lines of HCC induced by sorafenib, then to explore the genes related to sorafenib resistance in hepatocellular carcinoma.

METHODS

The human PLC and Huh7 cell lines were obtained, then the PLC and Huh7 drug-resistant cell lines were induced with sorafenib by using intermittent induction in vitro. CCK8 assay was used to detect the IC50 value of sorafenib for evaluation of drug sensitivity of hepatocellular carcinoma cell lines in PLC and Huh7. All the up regulated genes in PLC and Huh7 drug-resistant cell lines induced by sorafenib were screened out using high-throughput cDNA sequencing (RNA-Seq), Ualcan database was used to analyze the correlations between the up regulated genes in PLC and Huh7 drug-resistant cell lines induced and four clinical biological characteristics of hepatocellular carcinoma, including the gene expressions between normal samples and tumor samples, tumor stage, tumor grade, and patient overall survival, to find the genes that might be involved in the mechanism of sorafenib resistance of hepatocellular carcinoma.

RESULTS

All the up regulated genes detected by the using high-throughput cDNA sequencing (RNA-Seq) in PLC and Huh7 drug-resistant cell lines were further screened out by following conditions:(1) genes co-expressed in PLC and Huh7 drug-resistant cells induced by sorafenib, (2) the fold change was more than 4 times and the difference was statistically significant (P <0.05), the top 12 up regulated genes in PLC and Huh7 drug-resistant cell lines were found, which were TPSG1, CBX4, CLC, CLEC18C, LGI4, F2RL1, S100A6, HABP2, C15ORF48, ZG16, FOLH1, and EPCAM. Compared with the correlations between the twelve genes and the clinical biological characteristics by Ualcan database, the potentially significant gene CBX4 was screened out.

CONCLUSION

The human PLC and Huh7 drug-resistant cell lines of hepatocellular carcinoma induced by sorafenib were successfully established. CBX4, the gene related to sorafenib resistance in hepatocellular carcinoma, was screened out by the high-throughput cDNA sequencing (RNA-Seq) and further analysis using Ualcan database, which is providing a powerful basis for further research on the mechanism of sorafenib resistance of hepatocellular carcinoma.

[Research progress of miRNAs targeting GSK-3β in regulation of hepatocellular carcinoma invasion and metastasis]

Invasion and metastasis are key factors contributing to the high mortality rate of patients with hepatocellular carcinoma (HCC) involving a complex mechanism. In the invasion and metastasis of HCC, miRNAs can serve as either oncogenes or tumor suppressor genes to regulate the differentiation and proliferation of tumor cells being and play important roles in tumorigenesis, angiogenesis, invasion and metastasis. This review summarizes the recent progress in research of the molecular mechanisms by which miRNAs targeting GSK-3β regulate HCC invasion and metastasis and examines the roles of miRNAs in hepatocellular carcinoma cell proliferation, apoptosis, invasion, metastasis, and GSK-3β regulation.

[Differential diagnosis of hepatocellular carcinoma and hepatic hemangiomas based on radiomic features of gadoxetate disodium-enhanced magnetic resonance imaging]

OBJECTIVE

To evaluate the feasibility of using radiomic features for differential diagnosis of hepatocellular carcinoma (HCC) and hepatic cavernous hemangioma (HHE).

METHODS

Gadoxetate disodium-enhanced magnetic resonance imaging data were collected from a total of 135 HCC and HHE lesions. The radiomic texture features of each lesion were extracted on the hepatobiliary phase images, and the performance of each feature was assessed in differentiation and classification of HCC and HHE. In multivariate analysis, the performance of 3 feature selection algorithms (namely minimum redundancy-maximum relevance, mRmR; neighborhood component analysis, NCA; and sequence forward selection, SFS) was compared. The optimal feature subset was determined according to the optimal feature selection algorithm and used for testing the 3 classifier algorithms (namely the support vector machine, RBF-SVM; linear discriminant analysis, LDA; and logistic regression). All the tests were repeated 5 times with 10-fold cross validation experiments.

RESULTS

More than 50% of the radiomic features exhibited strong distinguishing ability, among which gray level co-occurrence matrix feature S (3, -3) SumEntrp showed a good classification performance with an AUC of 0.72 (P<0.01), a sensitivity of 0.83 and a specificity of 0.57. For the multivariate analysis, 15 features were selected based on the SFS algorithm, which produced better results than the other two algorithms. Testing of these 15 selected features for their average cross-validation performance with RBF-SVM classifier yielded a test accuracy of 0.82∓0.09, an AUC of 0.86∓0.12, a sensitivity of 0.88∓0.11, and a specificity of 0.76∓0.18.

CONCLUSION

The radiomic features based on gadoxetate disodium-enhanced magnetic resonance images allow efficient differential diagnosis of HCC and HHE, and can potentially provide important assistance in clinical diagnosis of the two diseases.

BMP-2在肝细胞癌中表达及与肿瘤血管生成的关系

目的

研究骨形成蛋白2(bone morphogenetic protein 2, BMP-2)在肝细胞癌(hepatocellular carcinoma, HCC)组织的表达情况及与肿瘤血管生成的关系.

方法

应用免疫组织化学方法检测BMP-2在40例HCC组织及40例癌旁组织的表达, 分析其与临床病理特征之间的关系, CD34染色标记肿瘤微血管密度(microvascular density, MVD).

结果

免疫组织化学显示, HCC组织中的BMP-2和血管内皮生长因子(vascular endothelial growth factor, VEGF)表达与癌旁组织中比较, 阳性率显著增加(75% vs 40%; 80.0% vs 42.5%, P<0.05), 并且BMP-2与VEGF蛋白表达与HCC包膜完整、结节、门静脉癌栓、TNM分期、细胞分化有关, 而与患者的年龄、性别、血清AFP、肝硬化无关. 根据Spearman相关性分析, BMP-2与VEGF蛋白表达呈正相关(r = 7.316, P = 0.0068), 提示BMP-2参与到肿瘤血管生成过程. HCC组织血管生成活跃(55% vs 15%, P <0.05), 血管生成与BMP-2表达有关.

结论

HCC中BMP-2高表达在肿瘤血管生成中有重要的作用.

[Expression of Wnt5b in patients with HBV-related hepatocellular carcinoma and its clinical significance]

OBJECTIVE

To investigate the expression of Wnt5b in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) tissues and its correlation with the clinicopathological parameters.

METHODS

Quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemical staining were employed to measure Wnt5b mRNA and protein expressions in two groups of HBV-related HCC patients (100 cases in each) selected from a cohort of 289 cases with HBV-related HCC using simple random sampling method. The correlation of Wnt5b expression with the clinicopathological parameters and the prognosis of HCC patients was analyzed.

RESULTS

Wnt5b mRNA expression was significantly higher in HCC tissues than that of adjacent noncancerous tissues in 65.0% (65/100) of the cases, and the positivity rate of Wnt5b protein was significantly higher in HCC tissues than that of adjacent noncancerous tissues (58.0% vs 22.0%, P<0.05). Wnt5b expression was significantly correlated with the tumor size (P<0.05), tumor number (P<0.01, only at the protein level), tumor differentiation (P<0.01, only at the protein level), TNM stage (P<0.05), BCLC stage (P<0.05), metastasis (P<0.05) and recurrence (P<0.01). The patients with up-regulated Wnt5b mRNA and protein had a shorter relapse-free survival (P<0.01).

CONCLUSION

s Up-regulated Wnt5b might contribute to the progression of HBV-related HCC and predicts a poor prognosis.

后DAA时代抗HCV治疗的现状及存在问题

近年来, 由于直接抗病毒药物(direct-acting antiviral agents, DAAs)具有高效、使用方便、不良反应小、疗程短、临床治愈率高的优点, 使其在临床的应用越来越广泛. 许多著名的制药公司对其研究不断, 其上市及更新的速度未减. 随着DAAs的广泛应用及指南更新, 抗丙型肝炎病毒(hepatitis C virus, HCV)的治疗已经步入全口服药物时期, 即已经步入后DAA时代. 但在使用DAAs抗HCV治疗过程中存在许多问题, 使用时需谨慎.