Hu Bin, Tian Xiaohui, Sun Jie, Meng Xiangjun
Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Road, Shanghai 200080, China.
Int J Mol Sci. 2013 Dec 2;14(12):23559-80. doi: 10.3390/ijms141223559.
The clinical value of Serum alpha-fetoprotein (AFP) to detect early hepatocellular carcinoma (HCC) has been questioned due to its low sensitivity and specificity found in recent years. Other than AFP, several new serum biomarkers including the circulating AFP isoform AFP-L3, des-gamma-carboxy prothrombin (DCP) and Golgi protein-73 (GP73) have been identified as useful HCC markers. In this investigation, we review the current knowledge about these HCC-related biomarkers, and sum up the results of our meta-analysis on studies that have addressed the utility of these biomarkers in early detection and prognostic prediction of HCC. A systematic search in PubMed, Web of Science, and the Cochrane Library was performed for articles published in English from 1999 to 2012, focusing on serum biomarkers for HCC detection. Data on sensitivity and specificity of tests were extracted from 40 articles that met the inclusion criteria, and the summary receiver operating characteristic curve (sROC) was obtained. A meta-analysis was carried out in which the area under the curve (AUC) for each biomarker or biomarker combinations (AFP, DCP, GP73, AFP-L3, AFP+DCP, AFP+AFP-L3, and AFP+GP73) was used to compare the diagnostic accuracy of different biomarker tests. The AUC of AFP, DCP, GP73, AFP-L3, AFP+DCP, AFP+AFP-L3, and AFP+GP73 are 0.835, 0.797, 0.914, 0.710, 0.874, 0.748, and 0.932 respectively. A combination of AFP+GP73 is superior to AFP in detecting HCC and differentiating HCC patients from non-HCC patients, and may prove to be a useful marker in the diagnosis and screening of HCC. In addition, the AUC of GP73, AFP+DCP and AFP+GP73 are better than that of AFP. The clinical value of GP73, AFP+DCP, or AFP+GP73 as serological markers for HCC diagnosis needs to be addressed further in future studies.
近年来，血清甲胎蛋白（AFP）用于检测早期肝细胞癌（HCC）的临床价值因其敏感性和特异性较低而受到质疑。除AFP外，包括循环AFP异构体AFP-L3、异常凝血酶原（DCP）和高尔基体蛋白73（GP73）在内的几种新型血清生物标志物已被确定为有用的HCC标志物。在本研究中，我们回顾了有关这些HCC相关生物标志物的现有知识，并总结了我们对探讨这些生物标志物在HCC早期检测和预后预测中效用的研究进行的荟萃分析结果。我们在PubMed、科学网和考克兰图书馆中进行了系统检索，以查找1999年至2012年发表的英文文章，重点关注用于HCC检测的血清生物标志物。从40篇符合纳入标准的文章中提取检测的敏感性和特异性数据，并获得汇总的受试者工作特征曲线（sROC）。进行了一项荟萃分析，其中使用每个生物标志物或生物标志物组合（AFP、DCP、GP73、AFP-L3、AFP+DCP、AFP+AFP-L3和AFP+GP73）的曲线下面积（AUC）来比较不同生物标志物检测的诊断准确性。AFP、DCP、GP73、AFP-L3、AFP+DCP、AFP+AFP-L3和AFP+GP73的AUC分别为0.835、0.797、0.914、0.710、0.874、0.748和0.932。AFP+GP73组合在检测HCC以及区分HCC患者和非HCC患者方面优于AFP，可能是HCC诊断和筛查中的一种有用标志物。此外，GP73、AFP+DCP和AFP+GP73 的AUC优于AFP。GP73、AFP+DCP或AFP+GP73作为HCC诊断血清学标志物的临床价值需要在未来研究中进一步探讨。
