Chang Te-Sheng, Wu Yu-Chih, Tung Shui-Yi, Wei Kuo-Liang, Hsieh Yung-Yu, Huang Hao-Chun, Chen Wei-Ming, Shen Chien-Heng, Lu Chang-Hsien, Wu Cheng-Shyong, Tsai Ying-Huang, Huang Yen-Hua
1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan [3] Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Am J Gastroenterol. 2015 Jun;110(6):836-44; quiz 845. doi: 10.1038/ajg.2015.100. Epub 2015 Apr 14.
Liver cirrhosis is a major risk factor for hepatocellular carcinoma (HCC), and all liver study societies recommend HCC surveillance in patients with cirrhosis. However, no ideal modality for HCC surveillance has been determined. The aim of this study is to assess the effectiveness of α-fetoprotein (AFP) measurement in HCC surveillance.
In this retrospective analysis, all patients with cirrhosis, who received HCC surveillance through ultrasound (US) and AFP measurement between January 2002 and July 2010, were followed up until June 2013. The performance effectiveness of surveillance using AFP, US, or both in HCC detection was compared.
Overall, 1,597 patients were followed for a median duration of 4.75 (range 1.42-12) years. Over the 8563.25-person-year follow-up period, 363 patients (22.7%) developed HCCs. For HCC detection, the area under the receiver operator characteristic curve of surveillance AFP was 0.844 (95% confidence interval: 0.820-0.868, P<0.001). When the traditional cutoff value of 20 ng/ml was used, the sensitivity and specificity of AFP were 52.9% and 93.3%, respectively. US exhibited a sensitivity and specificity of 92.0% and 74.2%, respectively. A combination of US and AFP exhibited a sensitivity and specificity of 99.2% and 68.3%, respectively. By using cut-off at 20 ng/ml and AFP level increase ≥2 × from its nadir during the previous 1 year, the combination of US and AFP yielded a sensitivity of 99.2% and an improved specificity of 71.5%.
The complementary use of AFP and US improved the effectiveness of HCC surveillance in patients with cirrhosis.
肝硬化是肝细胞癌（HCC）的主要危险因素，所有肝脏研究学会均建议对肝硬化患者进行HCC监测。然而，尚未确定用于HCC监测的理想方法。本研究的目的是评估甲胎蛋白（AFP）检测在HCC监测中的有效性。
在这项回顾性分析中，对2002年1月至2010年7月间通过超声（US）和AFP检测接受HCC监测的所有肝硬化患者进行随访，直至2013年6月。比较了使用AFP、US或两者进行监测在HCC检测中的性能有效性。
总体而言，1597例患者的中位随访时间为4.75年（范围1.42 - 12年）。在8563.25人年的随访期内，363例患者（22.7%）发生了HCC。对于HCC检测，监测AFP的受试者操作特征曲线下面积为0.844（95%置信区间：0.820 - 0.868，P<0.001）。当使用20 ng/ml的传统临界值时，AFP的敏感性和特异性分别为52.9%和93.3%。US的敏感性和特异性分别为92.0%和74.2%。US和AFP联合使用时，敏感性和特异性分别为99.2%和68.3%。通过使用20 ng/ml的临界值以及AFP水平较前一年最低点升高≥2倍，US和AFP联合使用时敏感性为99.2%，特异性提高至71.5%。
AFP和US的联合使用提高了肝硬化患者HCC监测的有效性。
