血清中的α-foetoprotein作为在恩替卡韦治疗监督检验肝癌的重

StephenW

Reappraisal of serum alpha-foetoprotein as a surveillance test for hepatocellular carcinoma during entecavir treatment

    Gi-Ae Kim,
    Chang Hyeon Seock,
    Jang Won Park,
    Jihyun An,
    Kwang-Sun Lee,
    Jee Eun Yang,
    Young-Suk Lim,
    Kang Mo Kim,
    Ju Hyun Shim,
    Danbi Lee and
    Han Chu Lee*

Article first published online: 21 MAR 2014

DOI: 10.1111/liv.12516

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Issue
Liver International

Volume 35, Issue 1, pages 232–239, January 2015

Author Information

    Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

* Correspondence
Han Chu Lee, MD, Professor
Department of Gastroenterology
Asan Medical Center
University of Ulsan College of Medicine,
88, Olympic-ro 43-gil
Songpa-gu
Seoul 138-736, Korea
Tel: +82-2-3010-3915
Fax: +82-2-485-5782
e-mail: [email protected]

    Gi-Ae Kim and Chang Hyeon Seock contributed equally to this study and share first authorship.


Abstract
Background & Aims

The aim of this study was to re-evaluate the diagnostic performance of alpha-foetoprotein (AFP) as a surveillance test for hepatocellular carcinoma (HCC) in patients with hepatitis B virus-related chronic liver disease who were treated with entecavir (ETV).
Methods

Between January 2007 and August 2012, we analysed 373 treatment-naïve patients with HBV-related chronic hepatitis (n = 229) or cirrhosis (n = 144) who were candidates for surveillance test, and were treated with ETV (0.5 mg/day) for longer than 12 months. To minimize the effect of AFP elevation caused by hepatitis activity, serum AFP levels were measured 12 months after the initiation of ETV treatment.
Results

Hepatocellular carcinoma developed in 28 patients (7.5%) during a median follow-up period of 48.0 months (IQR = 40.5–57.3 months). The area under the receiver operating characteristic curve for AFP was 0.71 (95% CI = 0.59–0.84). The optimal AFP cut-off value was 13 ng/ml, leading to a sensitivity of 50.0%, specificity of 98.8%, positive predictive value of 77.8% and negative predictive value of 96.1%. In multivariate Cox analysis, an older age, the presence of cirrhosis and AFP levels of ≥20 ng/ml at 12 months after treatment were found to be significantly associated with an increased incidence of HCC.
Conclusions

The role of serum AFP as a surveillance test should be re-evaluated in patients with HBV-related chronic liver diseases who were treated with antiviral therapy.

StephenW

血清中的α-foetoprotein作为在恩替卡韦治疗监督检验肝癌的重新评估

    GI-阂金，
    张铉Seock，
    张韩元公园，
    Jihyun安，
    刘广新利，
    梓恩阳，
    英淑林，
    康默金，
    李惠英沉，
    丹陛李和
    Han褚肋婀*

文章首次在网上公布：2014年3月21日

DOI：10.1111/ liv.12516

©2014年约翰·威利父子A / S。发布时间由John Wiley＆Sons出版有限公司

问题
肝国际

第35卷，第1期，页232-239，2015年1月

作者信息

    消化内科，肝病中心，峨山医学中心，医学蔚山大学，首尔，韩国系

*通讯
韩楚李医师，教授
消化内科
峨山医学中心
医学蔚山大学，
88，奥运-RO43吉
松坡区
首尔138-736，韩国
联系电话：+82-2-3010-3915
传真：+82-2-485-5782
电子邮件：[email protected]

    GI-阂Kim和昌贤Seock同等贡献这项研究并分享第一作者。


抽象
背景与目的

这项研究的目的是字母foetoprotein（AFP）的重新评估诊断表现为一种监督检验肝细胞癌（HCC）患者的乙肝病毒相关慢性肝病谁是恩替卡韦（ETV）治疗。
方法：

2007年1月和2012年8月之间，我们分析了373治疗初治患者HBV相关慢性肝炎（N =229）或肝硬化（N =144）谁是候选人的监督检验，并用恩替卡韦治疗（0.5毫克/天）对于超过12个月。为了最大限度地减少所造成的肝炎活性的AFP高程的效果，血清AFP水平测定ETV治疗开始12个月后。
结果

肝癌在中位随访48.0个月（IQR=40.5-57.3个月）开发的28例（7.5％）。受试者工作特征曲线AFP下面积为0.71（95％CI=0.59-0.84）。最优的AFP截止值为13纳克/毫升，导致50.0％，98.8％的特异性，77.8％，阳性预测值和96.1％阴性预测值的灵敏度。在多变量Cox分析中，年龄大，被发现肝硬化和在治疗后12个月≥20ng / ml的AFP水平的存在下，与肝癌的发生率增加来显著相关联。
结论

血清AFP作为监督检验的作用应得到重新评估患者的HBV相关慢性肝病谁是抗病毒治疗。

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