Test Characteristics of α-Fetoprotein for Detecting Hepatocellular Carcinoma in Patients with Hepatitis C

Gupta, Samir; Bent, Stephen; Kohlwes, Jeffrey

doi:10.7326/0003-4819-139-1-200307010-00012

Cited by 353 publications

(224 citation statements)

References 32 publications

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“…We ran another MEDLINE search using more specific terms (Appendix 2) and identified 985 additional articles to be reviewed. We also identified two systematic reviews on detecting HCC in patients with chronic hepatitis C [33,34] and checked their bibliographies. After reviewing titles and abstracts, 54 articles were retrieved for full-text evaluation.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

et al. 2007

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Background and aims The role of alphafetoprotein (AFP) in the diagnosis and surveillance of hepatocellular carcinoma (HCC) is getting smaller owing to the advances in imaging modalities. The aims of this study were to assess the diagnostic accuracy of tumor markers in small HCC and to find the optimal cutoff value of each tumor marker for efficient surveillance. Methods Studies in all languages were identified by searching MEDLINE from 1982 to 2002. Studies were included when they showed sensitivity and specificity for HCCs 5 cm or smaller and recruited only patients with chronic hepatitis or liver cirrhosis as control. We assessed diagnostic odds ratios (DORs) for the evaluation of diagnostic accuracy of tumor markers and positive likelihood ratios (LRs+) to find the optimal cutoff value. DORs and LRs+ were combined according to the random effect model. The summary receiver operating characteristics (ROC) curve was also assessed. Results Seventeen articles on three tumor markers-AFP, des-gamma-carboxyprothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)-were enrolled after full-text evaluation. AFP was inferior to DCP and AFP-L3 in both DOR (4.50 vs. 8.16 and 10.50) and area under the ROC curve (0.647 vs. 0.688 and 0.695). Optimal cutoff values that provide the best LR+ were 200 ng/ml for AFP, 40 mAU/ml for DCP, and 15% for AFP-L3. Conclusions Diagnostic accuracy of AFP in small HCC was substantially limited. Surveillance including other tumor markers with optimal cutoff value should be conducted to confirm the efficacy of the policy.

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Section: Resultsmentioning

confidence: 99%

“…During the literature-searching process, we identified two systematic reviews of the diagnostic accuracy of AFP [33,34]. Both of them focused on HCV-positive patients based on the concept that the natural history of hepatitis C is different from that of hepatitis B [6,40].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

et al. 2007

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“…Alpha-fetoprotein (AFP), which is widely used in clinical practice, has low sensitivity and poor diagnostic yield at the early stage of HCC (reported sensitivity, 39-64%; specificity, 76-91%; positive predictive value, 9-32%) (4,5). Accordingly, new markers, which have higher sensitivity and specificity, are needed to improve the diagnosis at the early stage and potentially increase the survival.…”

Section: Introductionmentioning

confidence: 99%

Combination of DKK1 and AFP improves diagnostic accuracy of hepatocellular carcinoma compared with either marker alone

Erdal

Utku²,

Karatay³

et al. 2016

Turk J Gastroenterol

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“…A systematic review and critical analysis of the literature, based on a Medline search from 1966 to 2002, indicated that for HCC screening, a serum AFP level >20 lg/L had a sensitivity of 41% to 65%, specificity of 80% to 94%, positive likelihood ratios of 3.1 to 6.8, and negative likelihood ratios of 0.4 to 0.6 for diagnosis of HCC. 23 This relatively poor performance, in addition to the unmet need for early HCC diagnosis, led us to a search for more sensitive and specific biomarkers of HCC. Because HCC is a highly vascular tumor, researchers have studied screening patients for markers of increased angiogenesis, which may be detected even before HCC is clinically manifest.…”

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confidence: 99%

Vascular endothelial growth factor in the management of hepatocellular carcinoma

Kaseb

Hanbali

Cotant

et al. 2009

Cancer

107

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The consumption of antidepressants, especially selective serotonine reuptake inhibitors (SSRI) has been increasing. Because a large fraction of the population is exposed, even a small excess of risk with respect to cancer should be considered. We carried out a record linkage study in Finland utilizing nationwide databases of reimbursed medication and cancer. The study population included all antidepressant drug (AD) users in Finland who had purchased at least 1 prescription between 1998 and 2005, and who had no cancer diagnosis at the date of first purchase. A control population without AD usage (matched by age and sex) was also included. Data consisted of 418,588 pairs of individuals that cumulated 3.3 million person‐years with an average of 4.0 years of follow‐up. 19,365 cancer cases were observed. The most frequent cancers were breast, prostate, lung, colon, and brain cancer. In general, only few associations between the utilization of AD and cancer could be detected. Over four years exposure to AD showed a weak association with increased colon and breast cancer incidence, which could have been caused by bias. As conclusion, no clear evidence of neither beneficial nor harmful association between usage of antidepressant and cancer was found.

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Test Characteristics of α-Fetoprotein for Detecting Hepatocellular Carcinoma in Patients with Hepatitis C

Cited by 353 publications

References 32 publications

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

Combination of DKK1 and AFP improves diagnostic accuracy of hepatocellular carcinoma compared with either marker alone

Vascular endothelial growth factor in the management of hepatocellular carcinoma

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