甲胎蛋白的纵向评估以早期发现肝硬化患者的肝细胞癌

StephenW

Longitudinal assessment of alpha-fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis
Mi Na KimORCID Icon, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han & show all
Received 28 Aug 2019, Accepted 19 Sep 2019, Published online: 08 Oct 2019

    Download citation https://doi.org/10.1080/00365521.2019.1673478 CrossMark Logo CrossMark


Abstract

Background/aims: Cirrhosis is an important risk factor for hepatocellular carcinoma (HCC), and the surveillance of patients with cirrhosis is, therefore, highly recommended. However, the role of alpha-fetoprotein (AFP) in HCC surveillance is controversial. The aim of this study was to determine the role of AFP in HCC surveillance among patients with cirrhosis.

Methods: The study population consisted of 392 patients with cirrhosis. Ultrasound (US) and laboratory tests including AFP were regularly performed to detect HCC development. The cutoff level of AFP for suspicion of HCC was 7 ng/mL.

Results: During the median follow-up period of 4.7 (interquartile range, 3.4–5.6) years, HCC developed in 64 (16.3%) patients. Their mean age was 53.6 years, and they were predominantly male (63.5%). For the detection of HCCs, the sensitivity and specificity of US were 56.3% and 100%, respectively. The sensitivity and specificity of AFP were 62.5% and 94.5%, respectively. Using US and AFP in combination increased the sensitivity of surveillance to 89.1% with a specificity of 94.5%. Mean AFP levels were significantly higher in patients with than without HCC at the time of HCC diagnosis, at 6 months and 12 months before the diagnosis. The area under the receiver operating characteristic curve of AFP was highest at the time of HCC diagnosis (0.867), and also was acceptable at 6 months (0.823) and 12 months (0.792) before the diagnosis.

Conclusions: These results suggest the complementary use of AFP and US to improve the effectiveness of HCC surveillance in patients with cirrhosis.
Keywords: HCC, surveillance, ultrasound, alpha-fetoprotein, cirrhosis

StephenW

甲胎蛋白的纵向评估以早期发现肝硬化患者的肝细胞癌
Mi Na KimORCID图标，Beom Kyung Kim，Seung Up Kim，Jun Yong Park，Sang Hoon Ahn，Kwang-Hyub Han＆显示全部
2019年8月28日收到，2019年9月19日接受，在线发布：2019年10月8日

下载引文https://doi.org/10.1080/00365521.2019.1673478 CrossMark徽标CrossMark


抽象

背景/目的：肝硬化是肝细胞癌（HCC）的重要危险因素，因此强烈建议对肝硬化患者进行监视。但是，甲胎蛋白（AFP）在HCC监测中的作用是有争议的。这项研究的目的是确定肝硬化患者中AFP在HCC监测中的作用。

方法：研究人群包括392例肝硬化患者。定期进行超声（美国）和包括AFP在内的实验室测试以检测HCC的发展。怀疑HCC的AFP临界值为7 ng / mL。

结果：在中位随访期4.7年（四分位间距3.4-5.6）年中，有64例（16.3％）患者发生了HCC。他们的平均年龄为53.6岁，其中以男性居多（63.5％）。对于HCC的检测，US的敏感性和特异性分别为56.3％和100％。 AFP的敏感性和特异性分别为62.5％和94.5％。结合使用US和AFP可将监视的敏感性提高到89.1％，特异性为94.5％。在进行HCC诊断时，诊断前6个月和12个月，患有HCC的患者的平均AFP水平显着高于未患有HCC的患者。在进行HCC诊断时，AFP的接收器工作特性曲线下的面积最高（0.867），在诊断前的6个月（0.823）和12个月（0.792）时也是可接受的。

结论：这些结果表明，AFP和US的补充使用可改善肝硬化患者HCC监测的有效性。
关键词：肝癌，监测，超声，甲胎蛋白，肝硬化