Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality in HCV-infected patients in the USA

Hb, El-Serag; Kramer, Daniel; Gj, Chen; Duan, Zhenfeng; Pa, Richardson; Davila, JA

doi:10.1136/gut.2010.230508

Cited by 90 publications

(94 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, it is subjective and dependent on operator experience and the available equipment (15)(16)(17)(18)(19)(20). Again, it is increasingly recognized that although screening by USS may be effective in specialized centers, this does not necessarily translate into an effective screening system in the wider community (21). Increasing levels of obesity in the West also limit the sensitivity of USS (22).…”

Section: Introductionmentioning

confidence: 99%

The Detection of Hepatocellular Carcinoma Using a Prospectively Developed and Validated Model Based on Serological Biomarkers

Johnson¹,

Pirrie

Cox³

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

246

244

View full text Add to dashboard Cite

Background: Hepatocellular carcinoma is a common complication of chronic liver disease (CLD), and is conventionally diagnosed by radiological means. We aimed to build a statistical model that could determine the risk of hepatocellular carcinoma in individual patients with CLD using objective measures, particularly serological tumor markers.Methods: A total of 670 patients with either CLD alone or hepatocellular carcinoma were recruited from a single UK center into a case-control study. Sera were collected prospectively and specifically for this study. A logistic regression analysis was used to determine independent factors associated with hepatocellular carcinoma and a model built and assessed in terms of sensitivity, specificity, and proportion of correct diagnoses.Results: The final model involving gender, age, AFP-L3, a fetoprotein (AFP), and des-carboxy-prothrombin ("GALAD") was developed in a "discovery" data set and validated in independent data sets both from the same institution and from an external institution. When optimized for sensitivity and specificity, the model gave values of more than 0.88 irrespective of the disease stage.Conclusions: The presence of hepatocellular carcinoma can be detected in patients with CLD on the basis of a model involving objective clinical and serological factors. It is now necessary to test the model's performance in a prospective manner and in a routine clinical practice setting, to determine if it may replace or, more likely, enhance current radiological approaches.Impact: Our data provide evidence that an entirely objective serum biomarker-based model may facilitate the detection and diagnosis of hepatocellular carcinoma and form the basis for a prospective study comparing this approach with the standard radiological approaches. Cancer Epidemiol Biomarkers Prev; 23(1); 144-53. Ó2013 AACR.

show abstract

Section: Introductionmentioning

confidence: 99%

The Detection of Hepatocellular Carcinoma Using a Prospectively Developed and Validated Model Based on Serological Biomarkers

Johnson¹,

Pirrie

Cox³

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

246

244

View full text Add to dashboard Cite

show abstract

“…While the risk factors for patients at the highest risk for developing HCC are well characterized, the early detection of liver cancer remains a challenge. The current screening tools of ultrasonography and measurement of α-fetoprotein (AFP) in the blood have limitations (5,6). In clinical practice, AFP is not elevated in a significant number of patients with HCC (7).…”

Section: Introductionmentioning

confidence: 99%

Serum levels of soluble CD25 as a marker for hepatocellular carcinoma

et al. 2012

View full text Add to dashboard Cite

Abstract. In a previous study, we showed that the level of soluble CD25 (sCD25) was elevated in a small series of patients with hepatocellular carcinoma (HCC). In the present study, we determined the capacity of serum levels of sCD25 to detect the presence and the early stage of HCC using a larger cohort of HCC patients and evaluated the correlation between sCD25 level and tumor burden. Serum levels of sCD25 were quantified using ELISA in patients with HCC (n=145), controls with advanced fibrosis (n=61) and healthy control subjects (n=30). The levels of sCD25 in patients with HCC (median, 6,955 pg/ml) were significantly higher than those in cirrhosis-only patients (4,310 pg/ml; P<0.0001). At a cut-off value of 2,180 pg/ml, sCD25 had a sensitivity of 92.3% and a specificity of 37.7% in detecting HCC presence [area under the curve (AUC) of 0.685; P<0.0001]. By comparison, α-fetoprotein (AFP) had a sensitivity of 53.8% and a specificity of 86.8% at a cut-off value of 32.8 ng/ml (AUC=0.755; P<0.0001) for HCC presence detection. For early HCC, the sensitivity of sCD25 was 89.6% and its specificity was 39.3% (AUC=0.630; P<0.0001) at a cut-off value of 2,859 pg/ml, while AFP had a sensitivity of 41.7% and a specificity of 82.6% at a cut-off value of 20.6 ng/ml (AUC=0.630; P=0.0257). We also found a significant positive correlation between serum levels of sCD25 and tumor stage. In the present study study, sCD25 was more effective than AFP at detecting the presence and early stages of HCC. This immune factor may hold promise as a novel predictive marker of HCC presence and may be useful in distinguishing early HCC from advanced cirrhosis, currently areas of global unmet need.

show abstract

“…Presumably, some of these rapidly growing neoplasms will be detected earlier with closer αFP measurements, especially in the subset of patients with genetic or phenotypic characteristics associated with very high risk for tumor development (17,19,20). As observed in adults, screening for hepatocarcinoma cirrhotic patients by serum αFP measurement resulted in increased survival rates (34). Moreover, the constant monthly rise in serum αFP was a more sensitive marker that transversal determinations with cut-offs, usually performed every 3-6 mo (35).…”

Section: Discussionmentioning

confidence: 95%

α-Fetoprotein assay on dried blood spot for hepatoblastoma screening in children with overgrowth-cancer predisposition syndromes

Mussa

Pagliardini

et al. 2014

Pediatr Res

View full text Add to dashboard Cite

Background: Beckwith-Wiedemann syndrome (BWS) and hemihyperplasia (HH) are overgrowth conditions with predisposition to hepatoblastoma for which early diagnosis patients undergo cancer screening based on determination of the tumor marker α-fetoprotein (αFP). Repeated blood draws are a burden for patients with consequent compliance issues and poor adherence to surveillance protocol. We sought to analyze feasibility and reliability of αFP dosage using an analytical micromethod based on blood dried on filter paper (DBS). Methods: Overall 143 coupled αFP determinations on plasma and DBS collected simultaneously were performed, of which 31 were in patients with hepatoblastoma predisposition syndromes and 112 were in controls. The plasma αFP dosage method was adapted to DBS adsorbed on paper matrix for newborn screening. results: There was strong correlation between plasmatic and DBS αFP (r 2 = 0.999, P < 0.001). Cohen's k coefficient for correlation was 0.96 for diagnostic cut-off of 10 U/ml (P < 0.001), commonly employed in clinical practice. The measurements on plasma and DBS were highly overlapping and consistent. conclusion: The DBS method allowed to dose αFP reliably and consistently for the concentrations commonly employed in clinical settings for the screening of hepatoblastoma, opening new scenarios about conducting cancer screening in overgrowth syndromes.

show abstract

Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality in HCV-infected patients in the USA

Abstract: Most patients with HCV-related cirrhosis do not receive regular imaging-based surveillance. The effectiveness of HCC surveillance tests in current clinical practice is rather modest in reducing HCC-related mortality.

Cited by 90 publications

References 25 publications

The Detection of Hepatocellular Carcinoma Using a Prospectively Developed and Validated Model Based on Serological Biomarkers

The Detection of Hepatocellular Carcinoma Using a Prospectively Developed and Validated Model Based on Serological Biomarkers

Serum levels of soluble CD25 as a marker for hepatocellular carcinoma

α-Fetoprotein assay on dried blood spot for hepatoblastoma screening in children with overgrowth-cancer predisposition syndromes

Contact Info

Product

Resources

About