Evaluation of Diagnostic Efficiency of Alpha-Fetoprotein in Patients with Liver Cirrhosis and Hepatocellular Carcinoma: Single-Center Experience
DOI:
https://doi.org/10.3889/oamjms.2018.344Keywords:
AFP, hepatocellular carcinoma, liver chirrosisAbstract
BACKGROUND: AFP serum levels are considered as diagnostic and specific for hepatocellular carcinoma (HCC) in patients with liver cirrhosis (LC).
AIM: This study aimed to examine the diagnostic value of AFP in the distinguishing of patients with HCC from patients with LC, and to analyse the potential correlation between AFP levels and liver disease stages.
MATERIAL AND METHODS: Fifty patients with LC and fifty patients with HCC were included in this study. The majority of the patients were males, while the HBV aetiology was dominant.
RESULTS: Significant differences between LC and HCC patients were detected for AST, ALT, GGT, bilirubin, AFP and AP. Patients with HCC had higher AFP values compared to LC. There was no significant correlation between the size of the tumour lesion and serum AFP levels. A positive correlation between AFP concentration and GGT activity was determined, as was the negative correlation between AFP and age of the subjects. The AFP value of 23.34 ng/m showed high sensitivity (84%) and specificity (82%).
CONCLUSION: The size of the surface below the ROC curve (AUC) was 0.877 (0.80-0.95), which makes AFP a good biomarker and this diagnostic test is sufficient to separate patients with HCC and LC.
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Kew MC. Epidemiology of chronic hepatitis B virus infection, hepatocellular carcinoma and hepatitis B virus-induced hepatocellular carcinoma. Pathol Biol. 2010; 58:27367. https://doi.org/10.1016/j.patbio.2010.01.005 PMid:20378277
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2009; 55:746108.
Nordenstedt H, White DL, El-Serag HB. The changing pattern of epidemiology in hepatocellular carcinoma. Dig Liver Dis. 2010; 42:206–214. https://doi.org/10.1016/S1590-8658(10)60507-5
Sherman M. Hepatocellular carcinoma: epidemiology, risk factors, and screening. Semin Liver Dis. 2005; 25:143–154. https://doi.org/10.1055/s-2005-871194 PMid:15918143
El-Seragh HB. Hepatocellular carcinoma and hepatitis C in the United States. Hepatology. 2002; 36: 74-83. https://doi.org/10.1002/hep.1840360710
McMahon BJ. Epidemiology and natural history of hepatitis B. Semin Liver Dis. 2005; 25:3-8. https://doi.org/10.1055/s-2005-915644 PMid:16103976
El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007; 132:2557-2576. https://doi.org/10.1053/j.gastro.2007.04.061 PMid:17570226
Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004; 127(1): 35-50. https://doi.org/10.1053/j.gastro.2004.09.014
Zhang JB, Chen Y, Zhang B, et al. Prognostic significance of serum gamma-glutamyl transferase in patients with intermediate hepatocellular carcinoma treated with transcatheter arterial chemoembolization. Eur J Gastroenterol Hepatol. 2011; 23(9): 787-793. https://doi.org/10.1097/MEG.0b013e32834902dd PMid:21730869
Wang Y, Chen Y, Ge N, et al. Prognostic significance of alpha-fetoprotein status in the outcome of hepatocellular carcinoma after treatment of transarterial chemoembolization. Ann Surg Oncol. 2012; 19(11): 3540-3546. https://doi.org/10.1245/s10434-012-2368-5 PMid:22532305
Yamazaki Y, Kakizaki S, Sohara N, et al. Hepatocellular carcinoma in young adults: the clinical characteristics, prognosis, and findings of a patient survival analysis. Dig Dis Sci. 2007; 52:1103–1107. https://doi.org/10.1007/s10620-006-9578-2 PMid:17380407
Chang PE, Ong WC, Lui HF, Tan CK. Is the prognosis of young patients with hepatocellular carcinoma poorer than the prognosis of older patients? A comparative analysis of clinical characteristics, prognostic features, and survival outcome. J Gastroenterol. 2008; 43:881–888. https://doi.org/10.1007/s00535-008-2238-x PMid:19012042
Aramaki M, Kawano K, Sasaki A, et al. Hepatocellular carcinoma in young adults. Hepatogastroenterology. 2005; 52:1795–1797. PMid:16334779
Harada T, Shigeta K, Noda K, et al. Clinical implications of alpha-fetoprotein in liver cirrhosis: five-year follow-up study. Hepatogastroenterology. 1980; 27:169-75. PMid:6161869
Arrieta O, RodrÃguez-DÃaz J, Rosas-Camargo V, et al. Colchicine delays the development of hepatocellular carcinoma in patients with hepatitisvirus related-liver cirrhosis. Cancer. 2006; 107:1852-1858. https://doi.org/10.1002/cncr.22198 PMid:16967451
Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL Conference. J Hepatol. 2001; 35: 421–430. https://doi.org/10.1016/S0168-8278(01)00130-1
Gómez Senent S, Gómez Raposo C, Segura Cabral JM. GuÃa para el diagnóstico, estadificación y tratamiento del hepatocarcinoma. Med Clin. 2007; 128:741-748. https://doi.org/10.1157/13106134
Hernandez JC, Samanda M, Roque A, et al. Diagnostic value of alfa-fetoprotein for hepatocellular carcinoma. Biotechnol Apl. 2011; 28(1):34-39.
Soresi M, Magliarisi C, Campagna P, et al. Usefulness of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma. Anticancer Res. 2003; 23(2C):1747-1753. PMid:12820452
Sherman M, Peltekian KM, Lee C. Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence and prevalence of hepatocellular carcinoma in a North American urban population. Hepatology. 1995; 22 (2):432-438. PMid:7543434
Oka H, Tamori A, Kuroki T, Kobayashi K, Yamamoto S. Prospective study of alpha-fetoprotein in cirrhotic patients monitored for development of hepatocellular carcinoma. Hepatology. 1994; 19(1):61-66. https://doi.org/10.1002/hep.1840190111 PMid:7506227
Pateron D, Ganne N, Trinchet JC, et al. Prospective study of screening for hepatocellular carcinoma in Caucasian patients with cirrhosis. J Hepatol. 1994; 20(1):65-71. https://doi.org/10.1016/S0168-8278(05)80468-4
McMahon BJ, Bulkow L, Harpster A, et al. Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: a 16-year population-based study. Hepatology. 2000; 32(4 Pt 1):842-846. https://doi.org/10.1053/jhep.2000.17914 PMid:11003632
Faraggi D, Reiser B. Estimation of the area under the ROC curve. Stat Med. 2002; 21:3093-3106. https://doi.org/10.1002/sim.1228 PMid:12369084
Epidemiološki nadzor nad zaraznim bolestima u Federaciji BiH, 2012. godina. Zavod za javno zdravstvo FBiH, služba za epidemiologiju. Bilten 2013:31.
Ertle JM, Heider D, Wichert M, et al. A combination of α-fetoprotein and des-γ-carboxy prothrombin is superior in detection of hepatocellular carcinoma. Digestion. 2013; 87:121–131. https://doi.org/10.1159/000346080 PMid:23406785
Johnson PJ. The role of serum alpha-fetoprotein estimation in the diagnosis and management of hepatocellular carcinoma. Clin Liver Dis. 2001; 5(1):145-159. https://doi.org/10.1016/S1089-3261(05)70158-6
Kailapuri GM, Mathews S, Jayanthi V, et al. Alpha-fetoprotein as a tumor marker in hepatocellular carcinoma: investigations in south Indian subjects with hepatotropic virus and aflatoxin etiologies. Int J Infect Dis. 2008; 12(6):71-76. https://doi.org/10.1016/j.ijid.2008.04.010 PMid:18658001
Biao ZA. Semiparametric hypothesis testing procedure for the ROC curve area under a density ratio model. CSDA. 2006; 7:1855-1876.
Trevisani F, D'Intino PE, Morselli-Labate AM, et al. Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status. J Hepatol. 2001; 34:570-575. https://doi.org/10.1016/S0168-8278(00)00053-2
Durazo FA, Blatt LM, Corey WG, et al. Des-gamma-carboxyprothrombin, alpha-fetoprotein and AFP-L3 in patients with chronic hepatitis, cirrhosis and hepatocellular carcinoma. J Gastroenterol Hepatol. 2008; 23(10):1541-1548. https://doi.org/10.1111/j.1440-1746.2008.05395.x PMid:18422961
El-Houseini ME, Mohammed MS, Elshemey WM, Hussein TD, Desouky OS, Elsayed AA. Enhanced detection of hepatocellular carcinoma. Cancer Control. 2005; 12(4):248-253. https://doi.org/10.1177/107327480501200407 PMid:16258497
Arrieta O, Cacho B, Morales-Espinosa D, Ruelas-Villavicencio A, Flores-Estrada D, Hernández-Pedro N. The progressive elevation of alpha fetoprotein for the diagnosis of hepatocellular carcinoma in patients with liver cirrhosis. BMC Cancer. 2007; 7:28-37. https://doi.org/10.1186/1471-2407-7-28 PMid:17288606 PMCid:PMC1803796
Bruix J, Sherman M. Management of hepatocellular carcinoma. AASLD Practice Guidelines. Hepatology. 2005; 42(5):2208-2236. https://doi.org/10.1002/hep.20933 PMid:16250051
Khan A, Asmaa I, Edward L, Waked I, Taylor-Robinson SD. Diagnosis of hepatocellular carcinoma. World J Gastroenterol. 2009; 15(11):1301-1314. https://doi.org/10.3748/wjg.15.1301
PMid:19294759 PMCid:PMC2658831
Darwish A. Assessment of Clinical Significance of Serum Squamous Cell Carcinoma Antigen in Patients with Liver Cirrhosis and Hepatocellular Carcinoma. Thesis submitted for partial fulfillment of the M.Sc. degree in tropical medicine, Faculty of medicine, Cairo University, 2006.
Abbasi A, Bhutto AR, Butt N, Mun SJ. Correlation of serum alpha fetoprotein and tumor size in hepatocellular carcinoma. J Pak Med Assoc. 2012; 62 (1): 33-36. PMid:22352098
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