意大利Padova大学的一个研究组发现，通过对因丙肝病毒（HCV）感染引发的肝硬化患者进行连续的鳞状细胞癌抗原（SCCA）和免疫球蛋白IgM检测，可以确定出患者在来年患上肝细胞癌的可能性。由于到目前为止，还没有血清生物标记物用于癌变监测，因此这一发现具有重要意义。
每年，大约有3％到4％的肝硬化患者患上原发性肝癌。那些肿瘤很小并容易通过手术切除或干扰的患者的预后最好。这些患者通常是通过超声波定期检查来监控的。
SCCA是一种丝氨酸蛋白酶抑制剂，在肝癌组织中高度表达。目前，意大利已经开发出一种对SCCA和IgM进行联合分析的新血清酶免疫吸收剂检测法。在8月15日的International Journal of Cancer杂志上，Pontisso博士的研究组报道了SCCA-IgA水平在未接受治疗的HCV肝硬化患者中随时间变化的关系。
研究人员对两组患者进行了研究：A组16名患者在四年内发生了肝细胞癌；B组17名患者在四年内没有发生癌变。两组最初具有相似的临床特征，包括SCCA-IgM血清水平相似（267 vs 249U/mL）。
但是，A组患者随着时间的推移，其SCCA-IgM水平显著增加。记录数据显示，A组75％的患者SCCA-IgM水平每年增加20U/mL，而B组患者则只有6％的患者以此幅度增加。SCCA-IgM水平在癌症临床诊断的至少1年前开始增加。
Pontisso博士的研究组表示，这种潜伏阶段可能成为研发新治疗药物和方法的一个窗口。一旦这些发现在更大规模的研究中被证实，那么监控SCCA-IgM复合体随时间的变化情况将可能成为肝硬化患者的一个有用的预后参数。
英文原文：
Biomarker predicts transition of cirrhosis to hepatocellular carcinoma
NEW YORK (Reuters Health) - Serial measurement of squamous cell carcinoma antigen (SCCA) complexed with IgM in patients with cirrhosis due to hepatitis C virus infection (HCV) may identify patients likely to develop hepatocellular carcinoma in the next year, an Italian research team has found. This finding may be of particular importance, because up until now there has been no serological biomarker for use in surveillance programs.
Approximately 3% to 4% of cirrhotic patients develop primary liver cancer every year, lead researcher Dr. Patrizia Pontisso, at the University of Padova, and associates note. The prognosis is best for patients whose tumors are small enough for surgical or ablative interventions. These patients are usually monitored over time with ultrasound follow-up.
SCCA, a serine protease inhibitor, is highly expressed in liver cancer tissue, and a new serologic enzyme-linked immunosorbent assay for SCCA complexed with IgM has been developed (Hepa-1C, Xeptagen SpA, Italy). In the International Journal of Cancer for August 15, Dr. Pontisso's group reports the association between SCCA-IgA levels over time among patients with untreated HCV cirrhosis.
Included were 16 patients who developed hepatocellular carcinoma during median follow-up of 4 years (group A) and 17 who remained cancer-free over the same period (group B). The two groups had similar clinical profiles at presentation, including comparable serum levels of SCCA-IgM (mean 267 versus 249 U/mL).
However, SCCA-IgM levels increased significantly more over time in group A patients. The researchers recorded an increase of > 20 U/mL/year in 75% of group A patients versus 6%of group B patients. SCCA-IgM levels started increasing at least 1 year before clinical diagnosis of cancer.
Dr. Pontisso's group writes: "This preclinical phase might become a suitable window to specifically address new potentially effective therapies." Once the findings are confirmed in larger studies, they add, "monitoring SCCA-IgM complexes' behavior over time could become a useful prognostic parameter in cirrhotic patients, to support clinical decisions."
