三种血清生物标志物检测早期肝细胞癌的纵向评估。

StephenW

Hepatology. 2018 Aug 28. doi: 10.1002/hep.30233. [Epub ahead of print]
Longitudinal Assessment of Three Serum Biomarkers to Detect Very Early Stage Hepatocellular Carcinoma.
Choi J1, Kim GA2, Han S3, Lee W4, Chun S4, Lim YS1.
1
    Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
2
    Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
3
    Department of Applied Statistics, Gachon University, Seongnam-si, Gyeonggi-do, Republic of Korea.
4
    Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract

We aimed to determine surveillance performance of alpha-fetoprotein (AFP), lectin-reactive AFP (AFP-L3), des-gamma-carboxy prothrombin (DCP), and their combinations for the early detection of hepatocellular carcinoma (HCC) by using prospectively collected longitudinal samples in patients at risk. Among 689 patients with cirrhosis and/or chronic hepatitis B who participated to four prospective studies, 42 HCC cases were diagnosed, selected, and matched with 168 controls for age, sex, etiology, cirrhosis, and duration of follow-up in a 1:4 ratio. Levels of AFP, AFP-L3, and DCP at the time of HCC diagnosis, month -6, and month -12 were compared between the cases and controls. Of 42 HCC cases, 39 (93%) had cirrhosis, 36 (85.7%) had normal alanine aminotransferase levels, and 31 (73.8%) had very early stage HCC (single <2 cm). AFP and AFP-L3 began to increase from 6 months before diagnosis of HCC in the cases (P<0.05), while they remained unchanged in the controls. At HCC diagnosis, the area under the receiver operator characteristic curves (AUROCs) for AFP, AFP-L3, and DCP were 0.77, 0.73, and 0.71, respectively. Combining AFP and AFP-L3 showed higher AUROC (0.83), while adding DCP did not further improve AUROC (0.86). With the optimal cutoff values (AFP, 5 ng/mL and AFP-L3, 4%), sensitivity and specificity of AFP and AFP-L3 combination were 79% and 87%, respectively. The sensitivity of ultrasonography was 48.6%, which was increased to 88.6% and 94.3% by adding AFP and AFP + AFP-L3, respectively.
CONCLUSION:

Among 3 biomarkers, AFP showed the best performance in discriminating HCC cases from controls. AFP and AFP-L3 combination adopting their novel cutoff values (5 ng/mL and 4%, respectively) significantly improved the sensitivity for detecting HCC at very early stage. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

AFP ; DCP ; HCC ; AFP-L3; Surveillance

PMID:
    30153338
DOI:
    10.1002/hep.30233

StephenW

肝病。 2018年8月28日doi：10.1002 / hep.30233。 [提前打印]
三种血清生物标志物检测早期肝细胞癌的纵向评估。
Choi J1，Kim GA2，Han S3，Lee W4，Chun S4，Lim YS1。
1
    韩国首尔蔚山医学院峨山医学中心肝脏中心消化内科。
2
    韩国首尔蔚山大学医学院牙山医疗中心健康检查与促进中心。
3
    韩国京畿道城南市Gachon大学应用统计系。
4
    韩国首尔蔚山大学医学院牙山医学中心检验医学系。
抽象

我们旨在通过前瞻性确定甲胎蛋白（AFP），凝集素反应性AFP（AFP-L3），去γ-羧基凝血酶原（DCP）及其组合的早期检测肝细胞癌（HCC）的监测性能。收集有风险患者的纵向样本。在参与4项前瞻性研究的689例肝硬化和/或慢性乙型肝炎患者中，42例HCC病例被诊断，选择并与168名年龄，性别，病因，肝硬化和随访时间的对照相匹配1： 4比率。比较病例和对照组在HCC诊断，月份-6和月份-12时的AFP，AFP-L3和DCP水平。在42例HCC病例中，39例（93％）患有肝硬化，36例（85.7％）具有正常的丙氨酸氨基转移酶水平，31例（73.8％）具有非常早期的HCC（单个<2cm）。 AFP和AFP-L3从HCC诊断前6个月开始增加（P <0.05），而对照组则保持不变。在HCC诊断中，AFP，AFP-L3和DCP的接收器操作员特征曲线（AUROC）下面积分别为0.77,0.73和0.71。 AFP和AFP-L3的组合显示出较高的AUROC（0.83），而添加DCP则没有进一步改善AUROC（0.86）。使用最佳截止值（AFP，5 ng / mL和AFP-L3，4％），AFP和AFP-L3组合的灵敏度和特异性分别为79％和87％。超声检查的敏感性为48.6％，分别加入AFP和AFP + AFP-L3，分别增加到88.6％和94.3％。
结论：

在3种生物标志物中，AFP在区分HCC病例和对照中表现出最佳表现。采用新型截断值（分别为5 ng / mL和4％）的AFP和AFP-L3组合显着提高了早期检测HCC的灵敏度。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

法新社; DCP; HCC; AFP-L3;监控

结论：
    30153338
DOI：
    10.1002 / hep.30233