Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: A comparison of AFP, DCP, and AFP-L31

Volk, Michael L.; Hernandez, James R.; Su, Grace L.; Lok, Anna S.; Marrero, Jorge A.

doi:10.3233/cbm-2007-3202

Cited by 125 publications

(103 citation statements)

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“…The 193 relevant articles were searched, of which 34 studies were eligible for inclusion, based on title and abstract. After assessment of the full text articles, 20 relevant articles (19 in English [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and 1 in Chinese [42]) including 5911 patients were available. A list of all the details abstracted from included studies was provided in table 1.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis

Gao¹,

Li²,

Tian³

et al. 2012

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Serum markers are needed to be developed to specifically diagnose Hepatocellular carcinoma (HCC). Des-γ-carboxy prothrombin (DCP) is a promising tool with limited expense and widely accessibility, but the reported results have been controversial. In order to review the performance of DCP for the diagnosis of HCC, the meta-analysis was performed. After a systematic review of relevant studies, the sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR, respectively) were pooled using a bivariate meta-analysis. Potential between-study heterogeneity was explored by meta-regression model. The post-test probability and the likelihood ratio scattergram to evaluate clinical usefulness were calculated. Based on literature review of 20 publications, the overall sensitivity, specificity, PLR and NLR of DCP for the detection of HCC were 67% (95%CI, 58%-74%), 92% (95%CI, 88%-94%), 7.9 (95%CI, 5.6-11.2) and 0.36 (95%CI, 0.29-0.46), respectively. The area under the bivariate summary receiving operating characteristics curve was 0.89 (95%CI, 0.85-0.92). Significant heterogeneity was present. In conclusion, the major role of DCP is the moderate confirmation of HCC. More prospective studies of DCP are needed in future.

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Section: Resultsmentioning

confidence: 99%

Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis

Gao¹,

Li²,

Tian³

et al. 2012

neo

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“…Several new HCC tumor markers have recently been clinically evaluated and found to be useful in HCC diagnosis, especially AFP-L3 and DCP [29,[32][33][34][35][36] as well as possibly hsp27, osteopontin, and glypican 3 [37][38][39][40][41]. The rapidly evolving fields of genomics and proteomics are now finding HCC-associated gene products that will likely find future usefulness in further defining HCC prognostic subsets [42][43][44], including metastasis potential [45][46][47].…”

Section: Discussionmentioning

confidence: 99%

Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a large case cohort study

2009

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Objectives 967 patients with unresectable and untransplantable, biopsy-proven hepatocellular carcinoma (HCC) were prospectively evaluated at baseline and followed up till death. Survival was the end point. Results We found that male gender, ascites, cirrhosis, portal vein thrombosis (PVT), elevated AFP or bilirubin, or alkaline phosphatase, were each statistically significant adverse prognostic factors. Patients with normal AFP survived longer than those with elevated AFP, even in the presence of PVT, large or bilobar tumors or cirrhosis. We used a bivariate analysis to separate patient sub groups based on liver function and tumor characteristics and found clear discrimination in survival between subsets; in addition both cirrhosis and presence of PVT were significant factors. We also used a purely mathematical approach to derive subgroups and a prognostic model for individual patients. Interestingly, the two approaches gave similar predictive information, which opens the possibility of a more detailed mathematical analysis in the future. The results of this large dataset show that amongst non-surgical HCC patients, there are clear subsets with longer survival. Conclusion The data supports the concept of heterogeneity of HCC. The three factors, bilirubin, AFP, and PVT predominate in prognosis.

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“…However, such cut off value is problematic in absolute diagnostic terms, since high levels of this magnitude are not as common in the presence of smaller tumors, furthermore; nor-mal AFP levels can be seen in approximately one-third of patients with HCC in this context. 29 A large multicenter study carried by Farinati et al based on both retrospecfic and prospective data collection, over a consecutive series of more than 1000 HCC patients, found that only 18% of studied patients had an AFP level >400 ng/ml, who also showed poor survival. 30 This discrepancy issue making detection and prognosis of HCC are very difficult.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of alpha-fetoprotein, YKL40 and GP73 in hepatocellular carcinoma Egyptian patients

et al. 2016

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INTRODUCTIONHepatocellular carcinoma (HCC) is the fifth most common malignancy in the world with high morbidity and mortality but its pathogenesis remains unclear. 1Because primary liver cancer is a growing concern showing poor prognosis due to its rapid infiltrating power and complicating liver cirrhosis; more attention were given to address the causal risk factors that could be preventable and/or treatable. 2HCC is phenotypically and genetically heterogeneous tumor, reflecting in part the heterogeneity of etiologic factors involved in (i) the onset of HCC development that is also influenced by age, gender and ethnic differences, (ii) the complexity of hepatocyte functions and epigenome leading to neo-plastic transformation and (iii) the late stage of HCC development. Methods:This study aimed to compare the diagnostic performance of AFP, YKL40 and GP73 in patients' serum with hepatocellular carcinoma (HCC) in high-risk population in an attempt to justify the new, sensitive, specific and rapid measure for the diagnosis and detection of HCC. Serum YKL40, GP73 and alpha-fetoprotein (AFP) were compared in a total of 60 human subjects in this study, including 20 healthy adults, and 40 patients with HCC, The main outcome measures were the specificity and sensitivity of YKL40 and GP73 in patients at risk for the development of HCC. Results: Using 4.4 relative units as a cut-off value, the sensitivity and specificity of serum GP73 for HCC were 85% and 90% compared with 77% and 60% for YKL40 using 21.06 ng/ml as a cut-off value. On the same context, the sensitivity and specificity of serum AFP at 8.5ng/ml cut-off were 82% and 95%. While that for the AFP and GP73 combined detection was up to 92% and 96%, justifying that the combined detection could prevent the false negative diagnosis by any marker alone and significantly improve the detection rate of HCC. Conclusions: The current evidence indicates that serum GP73 has HCC diagnostic efficacy inferior to that of AFP and YKL40 and the clinical implementation of serum GP73 measurement as a standard test for HCC is recommended alone or in combination with AFP.

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Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: A comparison of AFP, DCP, and AFP-L31

Cited by 125 publications

References 0 publications

Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis

Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis

Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a large case cohort study

Diagnostic performance of alpha-fetoprotein, YKL40 and GP73 in hepatocellular carcinoma Egyptian patients

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Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: A comparison of AFP, DCP, and AFP-L31

Cited by 125 publications

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Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis

Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis

Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a large case cohort study

Diagnostic performance of alpha-fetoprotein, YKL40 and GP73 in hepatocellular carcinoma Egyptian patients

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Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis

Diagnostic performance of Des-γ-carboxy prothrombin (DCP) for Hepatocellular carcinoma: A Bivariate Meta-analysis