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Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma
BACKGROUND: Alpha‐fetoprotein (AFP), routinely used for diagnosis of hepatocellular carcinoma (HCC), is limited with relatively low sensitivity and high false positivity in HBV‐related HCC (HBV‐HCC). Thus, an alternative approach was explored to improve specificity/sensitivity for diagnosis of HBV‐H...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196063/ https://www.ncbi.nlm.nih.gov/pubmed/32150664 http://dx.doi.org/10.1002/cam4.2968 |
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author | Ding, Yezhou Liu, Kehui Xu, Yumin Zhao, Qingqing Lou, Shike Xiang, Xiaogang Yan, Lei Cao, Zhujun Xie, Qing Zhu, Chuanwu Bao, Shisan Wang, Hui |
author_facet | Ding, Yezhou Liu, Kehui Xu, Yumin Zhao, Qingqing Lou, Shike Xiang, Xiaogang Yan, Lei Cao, Zhujun Xie, Qing Zhu, Chuanwu Bao, Shisan Wang, Hui |
author_sort | Ding, Yezhou |
collection | PubMed |
description | BACKGROUND: Alpha‐fetoprotein (AFP), routinely used for diagnosis of hepatocellular carcinoma (HCC), is limited with relatively low sensitivity and high false positivity in HBV‐related HCC (HBV‐HCC). Thus, an alternative approach was explored to improve specificity/sensitivity for diagnosis of HBV‐HCC, using the combination of AFP, inflammatory score, and liver function. METHODS: Chronic hepatitis B (CHB) (n = 510) and HBV‐HCC (n = 473) patients were identified retrospectively for this study. The diagnostic value of single vs combined biomarkers for HBV‐HCC was analyzed, using ROC curve. RESULTS: It was observed that elderliness, male sex, cirrhosis, HBeAg(+) or no‐antiviral therapy, and elevation of ALT, AST, neutrophil‐lymphocyte ratio (NLR), and AFP were associated with developing HBV‐HCC. However, the cut‐off ALT defined by Chinese standard, but not by AASLD, was a risk factor. Interestingly, AFP of HBeAg(‐) HBV‐HCC patients without cirrhosis was significantly higher than that of the HBeAg(+) patients. AUC values for AFP, ALT, AST, or NLR were 0.84 (95% CI: 0.815‐0.862), 0.533 (95% CI: 0.501‐0.565), 0.696 (95% CI: 0.666‐0.725), or 0.684 (95% CI: 0.654‐0.713) with optimal cut‐off at 7.21 ng/mL, 43 IU/mL, 38 IU/mL, or 2.61, respectively. Combination of AFP with ALT, AST, and NLR improved the diagnostic performance for HBV‐HCC, compared to any of the single biomarkers or any other combinations among these patients (except no‐cirrhosis). CONCLUSIONS: Elderliness, male sex, elevated ALT, AST, NLR, AFP, cirrhosis, HBeAg(+), and no‐antiviral treatment were independent risk factors for HBV‐HCC. AASLD standard of ALT cut‐off value may not be suitable for the Chinese population. Regular monitoring of HCC among HBeAg(‐) patients with abnormal AFP may improve the management of HBV‐HCC. The diagnostic performance of AFP combined with ALT, AST, and NLR for HBV‐HCC was superior to single biomarker or any other combinations among these patients, and its diagnostic equation can be used as useful tool for differentiation of HBV‐HCC from CHB. |
format | Online Article Text |
id | pubmed-7196063 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-71960632020-05-04 Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma Ding, Yezhou Liu, Kehui Xu, Yumin Zhao, Qingqing Lou, Shike Xiang, Xiaogang Yan, Lei Cao, Zhujun Xie, Qing Zhu, Chuanwu Bao, Shisan Wang, Hui Cancer Med Clinical Cancer Research BACKGROUND: Alpha‐fetoprotein (AFP), routinely used for diagnosis of hepatocellular carcinoma (HCC), is limited with relatively low sensitivity and high false positivity in HBV‐related HCC (HBV‐HCC). Thus, an alternative approach was explored to improve specificity/sensitivity for diagnosis of HBV‐HCC, using the combination of AFP, inflammatory score, and liver function. METHODS: Chronic hepatitis B (CHB) (n = 510) and HBV‐HCC (n = 473) patients were identified retrospectively for this study. The diagnostic value of single vs combined biomarkers for HBV‐HCC was analyzed, using ROC curve. RESULTS: It was observed that elderliness, male sex, cirrhosis, HBeAg(+) or no‐antiviral therapy, and elevation of ALT, AST, neutrophil‐lymphocyte ratio (NLR), and AFP were associated with developing HBV‐HCC. However, the cut‐off ALT defined by Chinese standard, but not by AASLD, was a risk factor. Interestingly, AFP of HBeAg(‐) HBV‐HCC patients without cirrhosis was significantly higher than that of the HBeAg(+) patients. AUC values for AFP, ALT, AST, or NLR were 0.84 (95% CI: 0.815‐0.862), 0.533 (95% CI: 0.501‐0.565), 0.696 (95% CI: 0.666‐0.725), or 0.684 (95% CI: 0.654‐0.713) with optimal cut‐off at 7.21 ng/mL, 43 IU/mL, 38 IU/mL, or 2.61, respectively. Combination of AFP with ALT, AST, and NLR improved the diagnostic performance for HBV‐HCC, compared to any of the single biomarkers or any other combinations among these patients (except no‐cirrhosis). CONCLUSIONS: Elderliness, male sex, elevated ALT, AST, NLR, AFP, cirrhosis, HBeAg(+), and no‐antiviral treatment were independent risk factors for HBV‐HCC. AASLD standard of ALT cut‐off value may not be suitable for the Chinese population. Regular monitoring of HCC among HBeAg(‐) patients with abnormal AFP may improve the management of HBV‐HCC. The diagnostic performance of AFP combined with ALT, AST, and NLR for HBV‐HCC was superior to single biomarker or any other combinations among these patients, and its diagnostic equation can be used as useful tool for differentiation of HBV‐HCC from CHB. John Wiley and Sons Inc. 2020-03-09 /pmc/articles/PMC7196063/ /pubmed/32150664 http://dx.doi.org/10.1002/cam4.2968 Text en © 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Cancer Research Ding, Yezhou Liu, Kehui Xu, Yumin Zhao, Qingqing Lou, Shike Xiang, Xiaogang Yan, Lei Cao, Zhujun Xie, Qing Zhu, Chuanwu Bao, Shisan Wang, Hui Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma |
title | Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma |
title_full | Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma |
title_fullStr | Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma |
title_full_unstemmed | Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma |
title_short | Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma |
title_sort | combination of inflammatory score/liver function and afp improves the diagnostic accuracy of hbv‐related hepatocellular carcinoma |
topic | Clinical Cancer Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196063/ https://www.ncbi.nlm.nih.gov/pubmed/32150664 http://dx.doi.org/10.1002/cam4.2968 |
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