Descritores: Carcinoma hepatocelular. Production of embryonal alpha-globulin by transplantable mouse hepatoma. Bruix J, Llovet JM. Major achievements in hepatocellular carcinoma. Clinical management of hepatocellular carcinoma.
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Servicios Personalizados Revista. Citado por SciELO. Similares en SciELO. In all, 22 patients AFP as a tumoral marker displayed a sensitivity of Keywords : hepatocelular carcinoma, cirrhosis, alpha-fetoprotein.
According to the available statistical data, it is the main cause of death in people with compensated hepatic cirrhosis HC , and variously alternates between the fifth and sixth position, according to the country, as the most frequent neoplasia to new cases worldwide per year. The diagnosis of HCC is often based on screening and surveillance strategies whose mainstays are the use of imagenological techniques and the measurement of the levels of serum alpha-fetoprotein AFP AFP is a 72 kDa onco-fetal glycoprotein with a size of aminoacids 6.
It is normally synthesized during fetal life, first in the yolk sac and then in fetal liver; its synthesis is normally repressed in adults 7. High levels of AFP are observed during adulthood only under certain conditions, such as pregnancy, the presence of some neoplasias e. HCC, gastric carcinoma, testicular carcinoma, lung cancer and pancreatic cancer and some non-neoplastic disorders such as HC and chronic hepatitis 8.
A new liver transplantation LT program began to be implemented and developed at the Center for Medical and Surgical Research CIMEQ starting from , a necessary part of which was the evaluation of cirrhotic patients in order to discard the presence of HCC. Therefore, a study was designed aimed at the identification of the factors associated to increased levels of serum AFP in the target population cirrhotic patients. A total of patients with HC of varying etiologies were evaluated and treated by the group specialized in liver transplantation LT.
The exclusion criteria were pregnancy, antecedents of other neoplasias and refusal of the patient to enter the study. Only two prospective patients were eliminated due to previous neoplasias. The data gathered for the investigation were obtained through the clinical evaluation of the patients using direct interviews, physical examinations, and the results of complementary studies contained in their medical records.
A diagnosis of HC was established by compliance with at least one of the following criteria: histology, laparoscopy, and unequivocal clinical signs of the disease, provided mainly by the physical exam, the imagenological elements of the sonograms and the results of the upper GI endoscopy. The HCC diagnosis took into account the criteria established by the European Association for the Study of Liver Disease EASLD for patients with HC and tumoral lesions larger than 2 cm, which produce a typical pattern of hypervascularization for imagenological techniques The AFP determinations were performed during the first evaluation visit of the patient, and then every 6 months.
The serum level of AFP related to the diagnosis, was corresponded with the first value of this tumoral marker at the moment of diagnosis of the disease. Mean value, standard deviation SD and median were computed for all quantitative variables; using percentages instead for qualitative parameters. The Tamhane test was used for statistically significant differences.
The calculation of the sensitivity and specificity reached when using different serum AFP thresholds for the diagnosis of HCC was carried out by constructing receiver operating characteristic ROC curves.
Viral hepatitis was the main cause of HC, with 83 cases Hepatitis C virus HCV was the most frequent viral agent, being involved in 59 of these 83 cases; in addition, two of these patients were co infected with the hepatitis B virus HBV , and other seven patients had problems with alcohol consumption. The second most common etiology was alcohol consumption, followed by cryptogenic cirrhosis, with 36 Twenty-two patients were diagnosed with HCC The remaining etiologies for HCC in this group were alcoholic HC and cryptogenic cirrhosis, with four The area under the curve amounted to 0.
All patients underwent imagenological tests, which supported the HCC diagnosis established with the study criteria. The combination of abdominal sonography and AFP increased sensitivity to The etiology of HC, on the other hand, is better known.
In developed countries, the causes of most HC cases are HCV infections and alcoholic liver disease 22 , while in other parts of the world, such as the Asian Southeast and sub-Saharan Africa, HBV infections constitute the main etiological agent The results of this study are conformed to our expectations. Viral infections, mainly by HCV, and alcohol consumption, were the first and second most important etiologies for HC, respectively.
This is the pattern typical of geographic areas where HBV infection is not endemic HC has been known for a long time as the most important risk factor for the development of HCC This investigation demonstrated the presence of HCC in The principal causes of HCC, ordered by frequency, were the presence of viral HC HCV-related mainly , the presence of cryptogenic cirrhosis, and the consumption of alcohol.
These data are similar to those reported in countries with low prevalence and incidence rates of HBV 11, Although serum AFP levels have been shown to increase in association with several carcinomas, this parameter has only been employed as a tumoral marker for HCC 28, The results coincide with previous reports investigating the influence of viral infections on AFP concentrations.
Searching for an explanation to this finding, several studies have demonstrated a correlation between increased serum AFP levels and the degree of inflammation observed in liver biopsies The investigations examining the usefulness of AFP as a screening and surveillance tool have not been directly comparable: their design and the characteristics of the studied population type of viral infection, severity of liver disease, demographics have differed.
A publication by Trevisiani et al. Lowering the threshold identifies a larger number of cases, improving sensitivity at the price of an increased false positive rate.
In other words, the higher the threshold, the lower the number of detected cases obtained sensitivity decreases. A different study by Gambarin-Gelman et al. More recent results from Durazo et al. Specificity in both studies was, however, discreetly lower.
Using a diagnostic threshold of This value also falls within the published range It can be concluded that serum AFP levels of This is a better outcome than that reported by Nguyen et al.
In the report from Trevisani et al. This variability has been ascribed not only to methodological differences in study populations, disease severity and non-uniform sampling frequencies, but also to susceptibilities to changes in tumor morphology, operator training and the quality of the measuring instrument 15, Regardless, abdominal sonography for HCC diagnosis performed, in this study, at levels of sensitivity and specificity much better than those presented in the preceding paragraph.
Although we cannot reach a definitive conclusion regarding this result, it may be related to the characteristics of the tumoral lesions and the long experience of the personnel operating the ultrasonographic equipment.
This combination aims, mainly, at simultaneously increasing both sensitivity and specificity for the diagnosis of HCC. The increase in sensitivity, compared to sonography alone, is 5. Values at the same order of sensitivity were reported by Kang et al.
No widely shared consensus has yet been reached concerning the combination of these tests, however; mainly due to the results of studies where the increases in false positive rates and operational costs are also taken into account Yet, we consider that this is a useful and feasible strategy aimed at increasing the chances of obtaining a timely HCC diagnosis.
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Vida después del diagnóstico de cáncer de testículo