Nörthen Aventinus, Asendorf Thomas, Walson Philip D, Oellerich Michael
Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany.
Clin Biochem. 2018 Feb;52:20-25. doi: 10.1016/j.clinbiochem.2017.10.011. Epub 2017 Oct 17.
Alpha-1-fetoprotein (AFP) is used to monitor progression, evaluate response to therapy and predict recurrence of hepatocellular carcinoma (HCC) in liver transplantation (LTx) patients. To date, the diagnostic value of serum AFP determinations for detecting tumor recurrence in HCC patients after LTx is unclear.
A retrospective, single-center, cross-sectional, non-interventional study was performed with the objective of determining post-transplant cut-off AFP values for detecting HCC recurrence post LTx.
Using receiver operating characteristic (ROC) analyses, post-transplant serum AFP values were evaluated against HCC recurrences in 63 HCC patients who had LTx between November 1995 and December 2011 at the University Medical Center Göttingen (UMG). Optimal and application-independent cut points for predicting tumor recurrence at 1, 3, and 5years after LTx were determined.
Post-LTx serum AFP was found to represent an independent risk factor (predictor) for HCC relapse. Post-operative AFP cut-off values of 7μg/l, 6μg/l, and 6μg/l, respectively, were determined to be optimal at 1, 3, and 5years after LTx respectively for predicting a HCC relapse. Using these cut-off values, patients were correctly classified as relapse-positive with a diagnostic sensitivity of 79%, 81%, and 77%, and as relapse-free with a specificity of 82%, 79%, and 69%. The diagnostic accuracy measured by area under the curve (AUC) values ranged from 0.813 to 0.886. However, a limitation is that at a clinically relevant specificity of ≥95%, the analyses showed sensitivity values of only 50%, 52%, and 50%, respectively.
Post-transplant serum AFP may have diagnostic value to detect HCC recurrence after LTx.
甲胎蛋白（AFP）用于监测肝移植（LTx）患者肝细胞癌（HCC）的进展、评估治疗反应及预测复发。迄今为止，血清AFP测定对检测LTx术后HCC患者肿瘤复发的诊断价值尚不清楚。
进行一项回顾性、单中心、横断面、非干预性研究，目的是确定用于检测LTx术后HCC复发的移植后AFP临界值。
采用受试者工作特征（ROC）分析，对1995年11月至2011年12月在哥廷根大学医学中心（UMG）接受LTx的63例HCC患者的移植后血清AFP值与HCC复发情况进行评估。确定了LTx后1年、3年和5年预测肿瘤复发的最佳且与应用无关的切点。
发现LTx术后血清AFP是HCC复发的独立危险因素（预测指标）。LTx术后1年、3年和5年预测HCC复发的AFP临界值分别确定为7μg/l、6μg/l和6μg/l。使用这些临界值，患者被正确分类为复发阳性，诊断敏感性分别为79%、81%和77%，被正确分类为无复发，特异性分别为82%、79%和69%。曲线下面积（AUC）值衡量的诊断准确性范围为0.813至0.886。然而，一个局限性在于，在临床相关特异性≥95%时，分析显示敏感性值分别仅为50%、52%和50%。
移植后血清AFP对检测LTx术后HCC复发可能具有诊断价值。
