Subject Category: Liver
Am J Gastroenterol 2015; 110:836–844; doi:10.1038/ajg.2015.100; published online 14 April 2015
Alpha-Fetoprotein Measurement Benefits Hepatocellular Carcinoma Surveillance in Patients with CirrhosisTe-Sheng Chang MD, PhD1,2,3, Yu-Chih Wu PhD3, Shui-Yi Tung MD1,4, Kuo-Liang Wei MD1, Yung-Yu Hsieh MD1, Hao-Chun Huang MD1, Wei-Ming Chen MD1,2, Chien-Heng Shen MD1,2, Chang-Hsien Lu MD2,5, Cheng-Shyong Wu MD1,4, Ying-Huang Tsai MD4,6 and Yen-Hua Huang PhD3,7,8,9,10
Correspondence: Yen-Hua Huang, PhD, Department of Biochemistry and Molecular Cell Biology, Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Taipei 110, Taiwan E-mail: [email protected]; Ying-Huang Tsai, MD, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, No. 6, Section West, Chiapu Road, Puzih, Chiayi 613, Taiwan. E-mail: [email protected]
Received 5 November 2014; Accepted 9 February 2015
Advance online publication 14 April 2015
Liver cirrhosis is a major risk factor for hepatocellular carcinoma (HCC), and all liver study societies recommend HCC surveillance in patients with cirrhosis. However, no ideal modality for HCC surveillance has been determined. The aim of this study is to assess the effectiveness of α-fetoprotein (AFP) measurement in HCC surveillance.
In this retrospective analysis, all patients with cirrhosis, who received HCC surveillance through ultrasound (US) and AFP measurement between January 2002 and July 2010, were followed up until June 2013. The performance effectiveness of surveillance using AFP, US, or both in HCC detection was compared.
Overall, 1,597 patients were followed for a median duration of 4.75 (range 1.42–12) years. Over the 8563.25-person-year follow-up period, 363 patients (22.7%) developed HCCs. For HCC detection, the area under the receiver operator characteristic curve of surveillance AFP was 0.844 (95% confidence interval: 0.820−0.868, P<0.001). When the traditional cutoff value of 20
ng/ml was used, the sensitivity and specificity of AFP were 52.9% and 93.3%, respectively. US exhibited a sensitivity and specificity of 92.0% and 74.2%, respectively. A combination of US and AFP exhibited a sensitivity and specificity of 99.2% and 68.3%, respectively. By using cut-off at 20
ng/ml and AFP level increase ≥2 × from its nadir during the previous 1 year, the combination of US and AFP yielded a sensitivity of 99.2% and an improved specificity of 71.5%.
The complementary use of AFP and US improved the effectiveness of HCC surveillance in patients with cirrhosis.
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