Gopal Purva, Yopp Adam C, Waljee Akbar K, Chiang Jason, Nehra Mahendra, Kandunoori Pragathi, Singal Amit G
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
Clin Gastroenterol Hepatol. 2014 May;12(5):870-7. doi: 10.1016/j.cgh.2013.09.053. Epub 2013 Oct 2.
BACKGROUND & AIMS: Measurements of α-fetoprotein (AFP) detect hepatocellular carcinoma (HCC) with low levels of sensitivity and specificity, and therefore are not recommended for use in liver cancer surveillance. However, AFP levels might accurately detect HCC in subgroups of patients. We performed a retrospective case-control study to identify features of patients with cirrhosis in whom levels of AFP correlated with HCC.
We collected data from patients with cirrhosis, with (n = 452) or without (n = 676) HCC, diagnosed at Parkland Hospital in Dallas, Texas, from January 2005 through June 2012. We determined sensitivities and specificities with which different levels of AFP identified those with HCC; multivariate logistic regression was used to associate accurate identification of HCC with patient features (age, sex, race/ethnicity, alcohol intake, smoking, etiology of cirrhosis, presence of decompensation, and laboratory test results). We assessed the overall accuracy of these factors in detecting HCC using receiver operator characteristic curve analysis and the Delong method. We calculated levels of AFP that detect HCC with the highest levels of sensitivity and specificity in subgroups using receiver operator characteristic analysis.
The most common etiologies of cirrhosis were hepatitis C virus (HCV) infection (60%) and alcohol induced (22%). Nearly 11% of patients were human immunodeficiency virus (HIV)-positive. Levels of AFP greater than 20 ng/mL detected HCC with 70.1% sensitivity and 89.8% specificity. This AFP level identified patients with HCC with a c-statistic of 0.87 (95% confidence interval, 0.85-0.89); it was significantly more accurate in HCV-negative patients than in HCV-positive patients (c-statistic, 0.89 vs 0.83; P = .007). AFP levels of 59 ng/mL or greater most accurately detected HCC in patients with HCV-associated cirrhosis; levels of AFP of 11 ng/mL or greater accurately identified HCC in HCV-negative patients. The level of AFP identified early stage HCC with a c-statistic of 0.62 (95% confidence interval, 0.58-0.66), and had a significantly higher level of accuracy for HIV-positive patients than for HIV-negative patients (c-statistic, 0.81 vs 0.59; P < .001).
Based on a retrospective analysis of data from patients with cirrhosis, with or without HCC, AFP level most accurately detects HCC in patients without HCV infection. It detects HCC with a high level of accuracy in patients with cirrhosis and HIV infection.
甲胎蛋白（AFP）检测对肝细胞癌（HCC）的敏感性和特异性较低，因此不建议用于肝癌监测。然而，AFP水平可能在部分患者亚组中能准确检测出HCC。我们进行了一项回顾性病例对照研究，以确定AFP水平与HCC相关的肝硬化患者的特征。
我们收集了2005年1月至2012年6月在得克萨斯州达拉斯帕克兰医院诊断为肝硬化的患者数据，其中有HCC的患者452例，无HCC的患者676例。我们确定了不同AFP水平检测HCC患者的敏感性和特异性；采用多因素逻辑回归分析将HCC的准确识别与患者特征（年龄、性别、种族/民族、酒精摄入量、吸烟、肝硬化病因、失代偿情况及实验室检查结果）相关联。我们使用受试者工作特征曲线分析和德龙方法评估这些因素检测HCC的总体准确性。我们通过受试者工作特征分析计算在亚组中检测HCC具有最高敏感性和特异性的AFP水平。
肝硬化最常见的病因是丙型肝炎病毒（HCV）感染（60%）和酒精性（22%）。近11%的患者为人类免疫缺陷病毒（HIV）阳性。AFP水平大于20 ng/mL检测HCC的敏感性为70.1%，特异性为89.8%。该AFP水平识别HCC患者的c统计量为0.87（95%置信区间，0.85 - 0.89）；在HCV阴性患者中比在HCV阳性患者中更准确（c统计量，0.89对0.83；P = 0.007）。AFP水平59 ng/mL或更高在HCV相关性肝硬化患者中最准确地检测出HCC；AFP水平11 ng/mL或更高在HCV阴性患者中准确识别出HCC。AFP水平识别早期HCC的c统计量为0.62（95%置信区间，0.58 - 0.66），在HIV阳性患者中的准确性显著高于HIV阴性患者（c统计量，0.81对0.59；P < 0.001）。
基于对有或无HCC的肝硬化患者数据的回顾性分析，AFP水平在未感染HCV的患者中最准确地检测出HCC。它在肝硬化合并HIV感染的患者中检测HCC具有较高的准确性。
