Improved Performance of Serum Alpha-Fetoprotein for Hepatocellular Carcinoma Diagnosis in HCV Cirrhosis with Normal Alanine Transaminase

The utility of alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) surveillance is controversial. We aimed to identify factors associated with elevated AFP and define the patients for whom AFP is effective for surveillance. Data from the NCI Early Detection Research Network phase II HCC bioma...

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Vydané v:Cancer epidemiology, biomarkers & prevention Ročník 26; číslo 7; s. 1085 - 1092
Hlavní autori: Yang, Ju Dong, Dai, Jianliang, Singal, Amit G, Gopal, Purva, Addissie, Benyam D, Nguyen, Mindie H, Befeler, Alex S, Reddy, K Rajender, Schwartz, Myron, Harnois, Denise M, Yamada, Hiroyuki, Gores, Gregory J, Feng, Ziding, Marrero, Jorge A, Roberts, Lewis R
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 01.07.2017
Predmet:
Adult
Aged
Alanine Transaminase - blood
Alcoholism - complications
alpha-Fetoproteins - analysis
Carcinoma, Hepatocellular - blood
Carcinoma, Hepatocellular - diagnosis
Carcinoma, Hepatocellular - pathology
Early Detection of Cancer - methods
Female
Hepacivirus - isolation & purification
Hepatitis B virus - isolation & purification
Humans
Liver Cirrhosis - blood
Liver Cirrhosis - etiology
Liver Neoplasms - blood
Liver Neoplasms - diagnosis
Liver Neoplasms - pathology
Male
Middle Aged
Neoplasm Staging
ROC Curve
ISSN:1538-7755
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Shrnutí:The utility of alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) surveillance is controversial. We aimed to identify factors associated with elevated AFP and define the patients for whom AFP is effective for surveillance. Data from the NCI Early Detection Research Network phase II HCC biomarker study (233 early-stage HCC and 412 cirrhotic patients) were analyzed. We analyzed 110 early-stage HCC and 362 cirrhotic hepatitis C virus (HCV) patients for external validation. Sensitivity, specificity, and area under the ROC curve (AUC) for HCC were calculated. HCV etiology, non-White race, and serum alanine transaminase (ALT) predicted elevated AFP in cirrhotics. Non-White race and ALT predicted elevated AFP in HCC patients. Higher AUC of AFP for HCC was noted in patients with HBV (0.85) and alcohol (0.84), whereas it was lower in patients with hepatitis C virus (HCV; 0.80) and nonviral/alcohol etiology (0.76). The AUC was higher in HCV patients with serum ALT ≤40 U/L than patients with serum ALT >40 U/L (0.91 vs. 0.75, < 0.01). At 90% specificity, the sensitivity of AFP increased from 44% to 74% in Whites with HCV and from 50% to 85% in non-Whites with HCV. There was a trend toward higher AUC in HCV patients with serum ALT ≤40 U/L than those with serum ALT >40 U/L (0.79 vs. 0.69, = 0.10) in the validation cohort. The satisfactory performance of AFP in HCV patients with normal ALT should be further validated. The AFP may serve as a valuable surveillance test in HCV patients with normal ALT. .
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ISSN:1538-7755
DOI:10.1158/1055-9965.EPI-16-0747