简单的临床指标可增强AFP，以有效地识别各种AFP水平的并发

StephenW

Front Oncol. 2020 Jan 24;9:1478. doi: 10.3389/fonc.2019.01478. eCollection 2019.
Simple Clinical Metrics Enhance AFP to Effectively Identify Cirrhotic Patients With Complicating Hepatocellular Carcinoma at Various AFP Levels.
Zhang X1, Wang T2, Zhang KH2, Chen SH2, He YT2, Wang YQ2.
Author information

1
    Center for Experimental Medicine Research, The First Affiliated Hospital of Nanchang University, Nanchang, China.
2
    Department of Gastroenterology, Jiangxi Institute of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Abstract

Background: Hepatocellular carcinoma (HCC) frequently occurs in cirrhosis and closely relates to poor prognosis of cirrhotic patients. Alpha-fetoprotein (AFP) is the most widely used biomarker in HCC diagnosis but not sensitive and specific to detect HCC at low AFP levels. In order to enhance the ability of AFP to detect HCC developed on cirrhosis, we attempted to combine AFP with conventional clinical metrics to develop a simple and effective method for identifying cirrhotic patients with complicating HCC at various AFP levels. Methods: Cirrhotic patients with or without HCC hospitalized to receive therapy for the first time were recruited and their clinical data were retrospectively collected. A model for diagnosing HCC was developed with routine clinical metrics and AFP by binary logistic regression analysis and internally validated. The goodness of fit, diagnostic accuracy and clinical usefulness of the model were evaluated using a calibration curve, the area under the receiver operating characteristic curve (AUROC) and a decision curve analysis, respectively. Results: A total of 574 patients with cirrhosis mainly caused by hepatitis B were recruited in this study, including 286 cases of simple cirrhosis (LC) and 288 cases of cirrhosis with HCC (LCC) (124 AFP-negative), with an average age of 53.2 ± 12.1 years and 81.4% males. Twelve of the 19 clinical metrics (age, gender, AFP, liver function tests, serum electrolytes, and coagulation tests) significantly differed between the LC and LCC groups. A model was successfully developed with age, AFP, Na+, Cl-, alkaline phosphatase, and activated partial thromboplastin time, which exhibited good performance in diagnosing LCC, with an AUROC of 0.918 (95%CI 0.895-0.940), 82.3% sensitivity, 89.5% specificity, and 85.9% accuracy for all patients, which were much higher values than those for AFP [0.846 (95%CI 0.815-0.878), 72.9, 81.5, and 77.2%, respectively]. For cirrhotic patients complicated with AFP-negative HCC, the model showed an AUROC of 0.854 (95%CI 0.812-0.896), 68.5% sensitivity, 86.6% specificity, and 80.0% accuracy. A high net benefit could be obtained in clinical decision making according to the model. Conclusion: A diagnostic model combining simple clinical metrics with AFP is valuable for the identification of cirrhotic patients complicating HCC with various AFP levels.

Copyright © 2020 Zhang, Wang, Zhang, Chen, He and Wang.
KEYWORDS:

alpha-fetoprotein; calibration curve analysis; clinical metrics; decision curve analysis; diagnostic model; hepatocellular carcinoma; liver cirrhosis

PMID:
    32038998
PMCID:
    PMC6993280
DOI:
    10.3389/fonc.2019.01478

StephenW

前Oncol。 2020年1月24日； 9：1478。 doi：10.3389 / fonc.2019.01478。 eCollection 2019。
简单的临床指标可增强AFP，以有效地识别各种AFP水平的并发肝细胞癌的肝硬化患者。
张X1，王T2，张KH2，陈SH2，何YT2，王YQ2。
作者信息

1
    南昌大学第一附属医院实验医学研究中心，南昌
2
    南昌大学第一附属医院江西省胃肠病研究所消化内科，南昌

抽象

背景：肝细胞癌（HCC）常发生于肝硬化，与肝硬化患者的不良预后密切相关。甲胎蛋白（AFP）是HCC诊断中使用最广泛的生物标志物，但对检测低AFP水平的HCC不敏感且特异。为了增强AFP检测肝硬化中发展的HCC的能力，我们尝试将AFP与常规临床指标相结合，以开发一种简单有效的方法来鉴定在各种AFP水平上使HCC复杂化的肝硬化患者。方法：招募初次住院或未接受肝癌治疗的肝硬化患者，并回顾性收集其临床资料。通过常规逻辑指标和AFP，通过二元Logistic回归分析开发了用于诊断HCC的模型，并进行了内部验证。分别使用校准曲线，接收器工作特征曲线（AUROC）下的面积和决策曲线分析来评估模型的拟合优度，诊断准确性和临床实用性。结果：本研究共招募了574例主要由乙型肝炎引起的肝硬化患者，包括286例单纯性肝硬化（LC）和288例HCC（LCC）肝硬化（124 AFP阴性），平均年龄53.2±12.1岁，男性占81.4％。 LC组和LCC组之间的19种临床指标（年龄，性别，AFP，肝功能检查，血清电解质和凝血检查）中有12个存在显着差异。成功开发了具有年龄，AFP，Na +，Cl-，碱性磷酸酶和活化的部分凝血活酶时间的模型，该模型在诊断LCC中表现出良好的表现，AUROC为0.918（95％CI 0.895-0.940），灵敏度为82.3％，所有患者的特异性为89.5％，准确性为85.9％，远高于AFP的值[分别为0.846（95％CI 0.815-0.878），72.9、81.5和77.2％]。对于肝硬化合并AFP阴性的肝癌患者，模型显示AUROC为0.854（95％CI 0.812-0.896），敏感性68.5％，特异性86.6％和准确度80.0％。根据该模型，在临床决策中可以获得很高的净收益。结论：将简单的临床指标与AFP相结合的诊断模型对于鉴定肝癌合并各种AFP水平的肝癌患者具有重要价值。

版权所有©2020 Zhang，Wang，Zhang，Chen，He and Wang。
关键字：

甲胎蛋白校准曲线分析；临床指标；决策曲线分析；诊断模型；肝细胞癌；肝硬化

PMID：
    32038998
PMCID：
    PMC6993280
DOI：
    10.3389 / fonc.2019.01478

StephenW

https://www.frontiersin.org/articles/10.3389/fonc.2019.01478/pdf