Abdel-Aziz Mohamed M, Elshal Mohamed F, Abass Aymn T, El-Kafrawy Sherif, Ezzat Sameera, Abdel-Wahab Mohamed
Clin Lab. 2016;62(6):1121-9. doi: 10.7754/clin.lab.2015.151102.
Hepatocellular carcinoma (HCC) has the worst prognosis among all major cancers, largely due to the lack of sensitive diagnostic markers. We aimed to compare three HCC tumor markers, alpha-fetoprotein (AFP), p53, and AFP-L3%, to evaluate whether measuring serum p53 levels and AFP-L3% has an additive diagnostic value for detection of HCC.
A total of 86 patients with chronic liver diseases were included. HCC was detected in 68 (79.1%) patients. Twenty healthy age-matched volunteers served as healthy controls. Serum concentrations of AFP, AFP-L3, and p53 protein were measured. The correlations between the three markers with status of viral hepatitis, liver function tests, and Child-Pugh scores were determined.
HCC patients showed significantly higher percentages of cirrhosis and Child-Pugh grade C (p < 0.001 and 0.05, respectively) compared with non-HCC group. AFP-L3% and p53 levels were significantly (p < 0.001, 0.0001, respectively) higher in HCC than non-HCC patients. AFP-L3% was found significantly correlated with Child-Pugh classification (p < 0.05) and alkaline phosphatase (p < 0.01). While, p53 significantly correlated with age and HCV positivity. ROC curve analysis showed that the highest specificity and sensitivity of the studied parameters are gained at cutoffs of 15%, 120.5 ng/mL, and 0.14 ng/mL for AFP-L3, AFP, and p53; respectively. Combining AFP-L3 and p53 improved sensitivity to 95.4% with a specificity of 85%.
No significant correlation was found between AFP, AFP-L3%, and p53; however, the simultaneous determination of the three tumor markers yielded a better diagnostic accuracy and sensitivity in the detection of HCCs than each biomarker alone.
肝细胞癌（HCC）在所有主要癌症中预后最差，这主要是由于缺乏敏感的诊断标志物。我们旨在比较三种HCC肿瘤标志物，即甲胎蛋白（AFP）、p53和AFP-L3%，以评估检测血清p53水平和AFP-L3%对HCC检测是否具有附加诊断价值。
共纳入86例慢性肝病患者。68例（79.1%）患者检测出HCC。20名年龄匹配的健康志愿者作为健康对照。检测血清AFP、AFP-L3和p53蛋白浓度。确定这三种标志物与病毒性肝炎状态、肝功能检查及Child-Pugh评分之间的相关性。
与非HCC组相比，HCC患者的肝硬化和Child-Pugh C级比例显著更高（分别为p<0.001和0.05）。HCC患者的AFP-L3%和p53水平显著高于非HCC患者（分别为p<0.001和0.0001）。发现AFP-L3%与Child-Pugh分级（p<0.05）和碱性磷酸酶（p<0.01）显著相关。而p53与年龄和HCV阳性显著相关。ROC曲线分析表明，对于AFP-L3%、AFP和p53，分别在截断值为15%、120.5 ng/mL和0.14 ng/mL时，所研究参数的特异性和敏感性最高。联合检测AFP-L3%和p53可将敏感性提高到95.4%，特异性为85%。
AFP、AFP-L3%和p53之间未发现显著相关性；然而，同时检测这三种肿瘤标志物在HCC检测中比单独检测每种生物标志物具有更高的诊断准确性和敏感性。
