The Study Of Serum Markers And Circulating Tumor Cells In Diagnosis And Therapeutic Effects Monitoring In Patients With Liver Carcinoma

Objective: Digestive system malignant tumor had been a major factor which influence human life. The morbidity and mortality in primary liver cancer were relatively high and it had been a common malignant tumor in digestive system. According to the《Liver Cancer Report 2015》and《Cancer statistics,2015》, more than 746 thousands people died of liver cancer in the world in 2012, and in 2015, about 880 thousands people were diagnosed of it in China. Early diagnosis of primary liver cancer had been an important major research direction due to the subtler early symptoms and difficultly treatment. The serum tumor marker detection was sensitivity and convenience,and it had an important value in guiding clinical treatment and judging the occurrence, metastasis, recurrence of tumor.The AFP、CEA、CA199 and AFP-L3 were routinely used biomarkers in diagnosing liver carcinoma,and the most common index was AFP. Circulating tumor cells were cells that had shed into the vasculature from a primary tumor and circulate in the bloodstream,in a sense we could use it in cancer diagnosing.This study was to evaluated the value of different tumor markers in diagnosing liver cancer by analyzing the different expression level of patients with liver cancer or healthy person, and investigate the significance of the heterogenicity of CTCs. In monitoring the treatment process, we evaluated the significance of CTC counting in the course of liver cancer treatment with sorafenib.Methods: Analysis was performed for the studies of 172 people from department of digestive oncology and department of minimally invasive therapy in oncology, in which 124 patients with liver cancer as experimental group and 48 patients with benign liver disease as control group, The serum level of AFP、CEA、CA199 and AFP-L3 were detected by chemilumunescence method. The expression of AFP>5.8IU/ml, CEA>4.3ng/ml, CA199>27.0U/ml and AFP-L3>1.0IU/ml or AFP-L3/AFP>0.1 were defined as critical value, which be used to evaluate the diagnostic value of AFP, AFP+CEA+CA199 and AFP-L3. The statistical analysis tools SPSS17.0 was used to analyze the data mentioned above.Analysis was performed for the studies of 64 people from department of digestive oncology, in which 34 with liver carcinoma(30 with hepatocellular carcinoma and 4 with intrahepatic cholangiocarcinoma) as experimental group and 30 healthy people as control group, evaluate the clinical value of diagnosing liver cancer. The quantity of CTCs in the peripheral blood is scarcely, so a novel integrated cellular and molecular approach with subtraction enrichment and immunostaining-FISH techniques had been used to capture these scarcely cells, and the phenotype of CK+/CD45-/CEP8=2, CK+/CD45-/CEP8≠2 and CK-/CD45-/CEP8≠2 were regarded as CTC. By analyzed the number and phenotype of CTCs, we evaluate the clinical value of CTCs in the liver cancer detection and treatment monitoring, and discuss the meaning of heterogeneity phenotype in different patients.Result:The positive rate and expression level of AFP, CEA, CA199 and AFP-L3 was higher in experimental group than that of in control group. The diagnostic value was better in combined AFP+CEA+CA199 than that using single AFP or AFP-L3. While the specificity of AFP-L3 could be 100%. CTC had a high sensitivity and specificity in the diagnosis, and the positive rate was associate with tumor stage. In this study, the major part CTCs we detected were CK- and CEP8≠2. In the progress of treatment monitoring, the target therapy was efficiently for the detecting of CTCs and measuring tumor metastases.Conclusion:1. Serum tumor markers expressed higher level in patients with liver cancer than that in benign patients.2. The value of diagnosis liver cancer that combined AFP+CEA+CA199 was better than that with single AFP or AFP-L3,while the specificity of AFP-L3 could be 100%.3. CTC could be a sensitive standard in diagnosing liver cancer, the characteristic of polyploid chromosome might reflect the malignancy of tumor and the number of CTC was associated with the stage of tumor.4. CTC could evaluated the prognosis of tumor therapy with liver cancer and monitored the progress of individual therapeutic.