Arginase-1联合Glypican-3在肝细胞肝癌和非肝脏来源肿瘤鉴别诊断中的意义

摘要

目的 观察肝细胞肝癌(hepatocellular carcinoma,HCC)、非肝脏来源肿瘤组织中精氨酸酶-1(Arginase-1,Arg-1)、磷月旨酰肌醇蛋白聚糖-3(Glypican-3,GPC-3)的表达及在病理诊断和鉴别诊断中的作用.方法 收集156例HCC、5例胆管细胞癌、20例肝脏转移癌和18例其他部位恶性肿瘤,应用免疫组化EnVision法检测两种蛋白的表达.结果 Arg-1在HCC及非肝脏来源肿瘤中的阳性率分别为93.6％ (146/156)和0(0/43),在HCC中的阳性率随着肿瘤分化程度的降低而减少(r=-0.264,P=0.001);GPC-3在HCC及非肝脏来源肿瘤中的阳性率分别为90.4％ (141/156)和14.0％ (6/43),在HCC中的阳性率随着肿瘤分化程度的降低而增加(r =0.179,P=0.026).Arg-1和GPC-3的敏感性、特异性、阳性预测值和阴性预测值分别为93.6％、100％、100％、81.1％和90.4％、86.0％、96.0％、71.2％.结论 Arg-1是敏感和特异的肝细胞标志物,对鉴别肝脏源性和非肝脏源性肿瘤有显著优势;GPC-3是诊断HCC特异性较高的标志物,尤其在低分化HCC的鉴别诊断中更有优势;联合应用Arg-1和GPC-3,对于HCC与肝脏转移癌的诊断与鉴别诊断具有重要意义.%Purpose To evaluate the expression of Arginine-1 (Arg-1) and Glypican-3 (GPC-3) in hepatocellular carcinoma (HCC) and non-hepatocellular carcinoma,as well as to summarize the related researches.Methods 156 cases of HCC,5 cases of cholangiocarcinoma,20 cases of metastatic adenocarcinoma and 18 cases of other types of tumors were studied.Immunohistochemical study for Arg-1 and GPC-3 was performed on the formalin-fixed and paraffin-embedded tumor tissues.Results The positive expression rates of Arg-1 in HCC and non-hepatocellular carcinoma were 93.6％ (146/156) and 0 (0/43),respectively,meanwhile the expression rate decreased with decreasing of differentiation (r =-0.264,P =0.001).GPC-3 expression was observed in 141 of 156 cases of HCC (90.4％) and 6 of 43 cases of non-hepatocellular carcinoma (14％),and the expression rate increased with decreasing of differentiation (r =0.179,P =0.026).The sensitivity,specificity,positive predictive value and negative predictive value of Arg-1 and GPC-3 in distinguishing HCC from non-hepatocellular carcinoma were 93.6％,100％,100％,81.1％ and 90.4％,86％,96.0％,71.2％,respectively.Conclusion Arg-1 is a sensitive and specific marker of hepatocytes.The application of Arg-1 and GPC-3 is of great significance in diagnosis of HCC and liver metastatic adenocarcinoma.