Minami Tatsuya, Tateishi Ryosuke, Kondo Masyuko, Nakagomi Ryo, Fujiwara Naoto, Sato Masaya, Uchino Koji, Enooku Kenichiro, Nakagawa Hayato, Asaoka Yoshinari, Kondo Yuji, Moriya Kyoji, Shiina Shuichiro, Koike Kazuhiko
From the Department of Gastroenterology (TM, RT, MK, RN, NF, MS, KU, KE, HN, YA, YK, KK); Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo (KM); Department of Gastroenterology, Juntendo University, Tokyo, Japan (SS).
Medicine (Baltimore). 2015 Jun;94(23):e901. doi: 10.1097/MD.0000000000000901.
Alpha-fetoprotein (AFP) has not played a large role in the surveillance of hepatocellular carcinoma due to inadequate sensitivity and specificity for active chronic hepatitis or cirrhosis. The aim of this study was to evaluate the diagnostic accuracy of AFP in small hepatocellular carcinomas after hepatitis C virus eradication to determine the optimal cutoff value. We conducted a case-control study of 29 cases and 58 controls, matched for age, gender, and platelet counts. The AFP cutoff was 5 ng/mL in patients after hepatitis C virus eradication and 17 ng/mL in those without hepatitis C virus eradication. The areas under the receiver operating characteristic curve were 0.86 (95% confidence interval, 0.76-0.96) in patients after hepatitis C virus eradication and 0.83 (95% confidence interval, 0.74-0.91) in those without hepatitis C virus eradication. In patients after hepatitis C virus eradication, the sensitivity and specificity of AFP levels were 24.1% and 100%, respectively, using a cutoff value of 17 ng/mL. Using a lower cutoff value of 5 ng/mL, the sensitivity increased to 75.9%, although the specificity decreased to 89.0%. AFP is a specific tumor marker for the diagnosis of hepatocellular carcinoma after hepatitis C virus eradication when using the optimal cutoff value of 5 ng/mL.
由于对活动性慢性肝炎或肝硬化的敏感性和特异性不足，甲胎蛋白（AFP）在肝细胞癌监测中未发挥重要作用。本研究旨在评估丙型肝炎病毒根除后AFP对小肝细胞癌的诊断准确性，以确定最佳临界值。我们进行了一项病例对照研究，纳入29例病例和58例对照，根据年龄、性别和血小板计数进行匹配。丙型肝炎病毒根除后的患者AFP临界值为5 ng/mL，未根除丙型肝炎病毒的患者为17 ng/mL。丙型肝炎病毒根除后的患者中，受试者操作特征曲线下面积为0.86（95%置信区间，0.76 - 0.96），未根除丙型肝炎病毒的患者中为0.83（95%置信区间，0.74 - 0.91）。在丙型肝炎病毒根除后的患者中，使用17 ng/mL的临界值时，AFP水平的敏感性和特异性分别为24.1%和100%。使用5 ng/mL的较低临界值时，敏感性增至75.9%，但特异性降至89.0%。当使用5 ng/mL的最佳临界值时，AFP是丙型肝炎病毒根除后诊断肝细胞癌的特异性肿瘤标志物。
