Chan Stephen L, Mo Frankie, Johnson Philip J, Siu Deyond Y W, Chan Michael H M, Lau Wan Y, Lai Paul B S, Lam Christopher W K, Yeo Winnie, Yu Simon C H
State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, Hong Kong, China.
HPB (Oxford). 2014 Apr;16(4):366-72. doi: 10.1111/hpb.12146. Epub 2013 Aug 26.
The role of serum α-fetoprotein (AFP) measurements in the diagnosis of hepatocellular carcinoma (HCC) remains controversial. Some guidelines have advised against the use of AFP in the diagnosis of HCC. This study was conducted to evaluate the performance of AFP in the diagnosis of HCC, and to identify the optimal cut-off value of serum AFP in the diagnosis of HCC in patients with a hepatic mass.
Patients who presented during the period from May 1997 to March 2003 with hepatic lesions, for whom paired data on serum AFP values at baseline and lesion histology were available, were reviewed. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis.
Data for a total of 805 patients were evaluated. The mean AFP value was 26,900 ng/ml (range: 0-1,965,461 ng/ml). The histological diagnosis was HCC in 557 patients. The optimal AFP cut-off value was 10 ng/ml (for sensitivity of 82.6% and specificity of 70.4%). At a cut-off level of 200 ng/ml, sensitivity, specificity, and positive and negative predictive values were 47.7%, 97.1%, 97.5% and 44.4%, respectively. The diagnostic performance of AFP remains similar in patients with chronic hepatitis B virus infection, despite a lower negative predictive value. Common aetiologies of liver lesions associated with elevated AFP include cholangiocarcinoma and neuroendocrine tumours.
In Asian patients with suspicious liver lesions, the cut-off AFP level of 200 ng/ml is useful to achieve a diagnosis of HCC with high specificity and reasonable sensitivity. The measurement of serum AFP should not be excluded from guidelines for the diagnosis of HCC.
血清甲胎蛋白（AFP）检测在肝细胞癌（HCC）诊断中的作用仍存在争议。一些指南建议不要将AFP用于HCC的诊断。本研究旨在评估AFP在HCC诊断中的性能，并确定血清AFP在肝占位患者HCC诊断中的最佳临界值。
回顾性分析1997年5月至2003年3月期间出现肝脏病变且有基线血清AFP值和病变组织学配对数据的患者。使用受试者工作特征曲线分析确定AFP在HCC诊断中的性能。
共评估了805例患者的数据。AFP的平均水平为26,900 ng/ml（范围：0 - 1,965,461 ng/ml）。组织学诊断为HCC的患者有557例。AFP的最佳临界值为10 ng/ml（灵敏度为82.6%，特异度为70.4%）。在临界值为200 ng/ml时，灵敏度、特异度、阳性预测值和阴性预测值分别为47.7%、97.1%、97.5%和44.4%。尽管阴性预测值较低，但在慢性乙型肝炎病毒感染患者中，AFP的诊断性能仍然相似。与AFP升高相关的肝脏病变的常见病因包括胆管癌和神经内分泌肿瘤。
在有可疑肝脏病变的亚洲患者中，200 ng/ml的AFP临界值有助于以高特异度和合理灵敏度诊断HCC。血清AFP检测不应被排除在HCC诊断指南之外。
