Background: The aims of this study were to evaluate the diagnostic and prognostic roles of serum osteopontin (OPN) and single nucleotide polymorphisms (SNPs) in the OPN promoter in patients with hepatitis B-related hepatocellular carcinoma (HCC). Materials and Methods: Four groups were studied, which included 157 patients with HCC, 73 with liver cirrhosis (LC) and 97 with chronic hepatitis (CH), along with 80 healthy subjects. Serum OPN and alpha-fetoprotein (AFP) levels were measured. The SNPs -66 T/G, -156 G/ΔG and -433 C/T within the OPN promoter were determined by direct sequencing. Results: Serum OPN levels were significantly higher in patients with HCC than in the other groups. Area under receiver operating characteristics curves in distinguishing HCC from chronic liver disease (CLD; CH and LC) were 0.782 (95% CI; 0.729-0.834) for OPN and 0.888 (95% CI; 0.850-0.927) for AFP. Using the optimal cut-off value (70 ng/mL), OPN had sensitivity and specificity of 72% and 71%, respectively. Serum OPN was superior to AFP in detecting early-stage HCC (68% vs. 46%). A combination of both markers yielded an improved sensitivity for detecting early HCC to 82%. A high OPN level was significantly correlated with advanced BCLC stage and was an independent prognostic factor for HCC. The SNPs -156 and -443 were associated with susceptibility to HCC, but were not related to overall survival. Conclusions: Serum OPN is a useful diagnostic and prognostic marker for HCC. The combined use of serum OPN and AFP improved the diagnosis of early HCC. Genetic variation in the OPN promoter is associated with the risk, but not the prognosis of HCC.
DESCRIPTIONA 79-year-old Thai man with a history of untreated mid-oesophageal cancer presented with progressive dyspnoea and productive cough for 3 weeks. On examination, he had low-grade fever, tachyponea, regular pulse rate at 110/min, blood pressure 120/ 78 mm Hg without definite pulsus paradoxus. Pulmonary examination showed mild deviation of trachea to the right, dullness on percussion and decreased breath sound at the left lung. He also had mildly distended neck veins, decreased cardiac sound and decreased apical impulse. ECG revealed sinus tachycardia with low QRS voltage without significant ST-T change. A large amount of generalised high-echoic pericardial fluid and evidences of early cardiac temponade were demonstrated by transthoracic echocardiography.Contrast-enhanced CT of the chest showed known circumferential oesophageal mass at the middle one-third of the oesophagus (black asterisk, figure 1A). A large amount of circumferential pericardial fluid (white asterisks, figure 1A-C) with small air bubbles (bold arrows, figure 1A-C) were detected. In addition, large loculated fluid collections in left hemithorax with air-fluid level and pleural enhancement (open arrows, figure 1A,C) were observed. Subsequent pericardiocentesis along with left intercostal drainage were performed, which revealed similar findings of large volume of frank, yellowish, foul-smelling pus (figure 2), consistent with pyopneumopericardium and empyema thoracis. On the basis of these findings, the patient underwent surgery with the presumptive diagnosis of the perforation of necrotic oesophagus leading to direct spread of infection to adjacent organs. Intraoperative finding confirmed the ruptured oesophagus at mid-thoracic level as a consequence of local tumour invasion. He successfully underwent combined drainage of pus in pericardial space with pericardiectomy, decortication of left lung and resection of the thoracic oesophagus from just below aortic arch to oesophagogastric junction. Microbiological cultures of pus were positive for mixed organisms including Pseudomonas aueruginosa, Streptococcus group D and Streptococcus group G. Postoperative period was uneventful and he is currently in the restoration process of enteral alimentation before being discharged.Perforation of oesophageal cancer is a serious circumstance that most often results from either diagnostic or therapeutic instrumentation, that is, stent placement.
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