A threshold analysis of alpha-fetoprotein in diagnosis and screening of hepatocellular carcinoma
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摘要:
目的探讨AFP在原发性肝癌(HCC)诊断和早期筛查中的最佳阈值。方法收集2007年-2017年于南京医科大学附属淮安第一医院住院、门诊和健康体检确诊的2212例HCC和1998例非HCC患者的临床资料,统计AFP水平。将AFP水平划分为1020μg/L、2165μg/L、66110μg/L、111155μg/L、156200μg/L、201250μg/L、251300μg/L、301350μg/L、351400μg/L、> 400μg/L 10个阈值。比较各阈值、B超以及二者联合诊断HCC的联合敏感度、特异度、阳性似然比、阴性似然比、诊断优势比。构建受试者工作特征曲线(ROC曲线)测定最佳诊断阈值。结果 AFP阈值201250μg/L组的灵敏度与特异度之和最大(1. 370 1),ROC曲线下面积最大(0. 896 4)。AFP> 20μg/L联合B超诊断肝...
Abstract:Objective To investigate the optimal cut-off value of alpha-fetoprotein ( AFP) in the diagnosis and early screening of hepatocellular carcinoma ( HCC) . Methods The clinical data of 2212 HCC patients who were diagnosed and hospitalized in our hospital and 1998 non-HCC patients were collected, and the AFP level was summarized. The AFP level was divided into 10 ranges of 10-20 μg/L, 21-65μg/L, 66-110 μg/L, 111-155 μg/L, 156-200 μg/L, 201-250 μg/L, 251-300 μg/L, 301-350 μg/L, 351-400 μg/L, and >400 μg/L, and a comparative analysis was performed for the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of each cut-off value of AFP, ultrasound, and their combination in the diagnosis of HCC. The receiver operating characteristic ( ROC) curve was plotted to determine the optimal cut-off value. Results The cut-off valve of AFP of 200-250 μg/L had the largest sum of sensitivity and specificity ( 1. 370 1) and the largest area under the ROC curve ( 0. 896 4) . AFP > 20 μg/L combined with ultrasound had the highest sensitivity ( 95. 35%) in the diagnosis of HCC, with a diagnostic odds ratio of 26. 13. Conclusion The optimal cut-off value of AFP in the diagnosis of HCC is 200 μg/L. When AFP combined with ultrasound is used for the screening of people at a high risk of HCC, AFP > 20 μg/L is recommended as a positive index, and its combination with differential diagnosis and close follow-up and examinations can reduce the false negative rate of screening.
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Key words:
- alpha-fetoproteins /
- liver neoplasms /
- reference values /
- diagnosis /
- mass screening
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[1] XU JY, LIN D, LI WD, et al. A systematic review of the accuracy of diagnostic test of AFP for Chinese primary liver cancer[J]. Chin J Evid-based Med, 2009, 9 (5) :525-530. (in Chinese) 徐建业, 林丁, 李伟道, 等.甲胎蛋白诊断原发性肝癌准确性的系统评价[J].中国循证医学杂志, 2009, 9 (5) :525-530. [2] ZHANG JH, WANG JY. The diagnosis of hepatocellular carcinoma with low positive serum AFP level:An analysis of 424 cases[J].Chin J Gen Surg, 2002, 17 (9) :36-37. (in Chinese) 张建淮, 王建营.甲胎蛋白低浓度阳性肝细胞癌424例的诊断分析[J].中华普通外科杂志, 2002, 17 (9) :36-37. [3] LIU YR, LIN BB, ZENG DW, et al. Alpha-fetoprotein level as a biomarker of liver fibrosis status:A cross-sectional study of 619consecutive patients with chronic hepatitis B[J]. BMC Gastroenterol, 2014, 14 (1) :145. [4] ZHANG XM, WEI MJ, XU ZJ, et al. Pattern of serumα-fetal protein, intereleukin-6 and Golgi protein 73 expressed in liver diseases and their diagnostic value on hepatocellular carcinoma[J/CD]. Chin J Exp Clin Infect Dis:Electronic Edition, 2017, 11 (4) :339-344. (in Chinese) 张小曼, 魏梅娟, 许正锯, 等.血清甲胎蛋白、白细胞介素-6和高尔基体蛋白73在肝脏疾病中的表达特点及其对肝细胞癌的诊断价值[J/CD].中华实验和临床感染病杂志:电子版, 2017, 11 (4) :339-344. [5] REIM D, CHOI YS, YOON HM, et al. Alpha-fetoprotein is a significant prognostic factor for gastric cancer:Results from a propensity score matching analysis after curative resection[J]. Eur J Surg Oncol, 2017, 43 (8) :1542-1549. [6] LI W, BAI Y, LI YT, et al. Clinical application and laboratory evaluation of alpha fetoprotein[J]. Clin Misdiagn Misther, 2007, 20 (8) :97-100. (in Chinese) 李玮, 白云, 李云婷, 等.甲胎蛋白的临床应用及实验室评价[J].临床误诊误治, 2007, 20 (8) :97-100. [7] LU NN, ZHANG YH, WANG HY, et al. Value of serum alphafetoprotein and protein induced by vitamin K absence or antagonist-II in pathological diagnosis of hepatocellular carcinoma[J]. J Clin Hepatol, 2017, 33 (11) :2162-2165. (in Chinese) 鹿宁宁, 张英华, 王海燕, 等.血清甲胎蛋白联合维生素K缺乏或拮抗剂Ⅱ诱导蛋白在肝细胞癌病理诊断中的应用价值[J].临床肝胆病杂志, 2017, 33 (11) :2162-2165. [8] National Health and Family Planning Commission of the People’S Republic of China. Diagnosis, management, and treatment of hepatocellular carcinoma (V2017) [J]. J Clin Hepatol, 2017, 33 (8) :1419-1431. (in Chinese) 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范 (2017年版) [J].临床肝胆病杂志, 2017, 33 (8) :1419-1431. [9] CEDRONE A, COVINO M, CATURELLI E, et al. Utility of alphafetoprotein (AFP) in the screening of patients with virus-related chronic liver disease:does different viral etiology influence AFP levels in HCC? A study in 350 western patients[J]. Hepatogastroenterology, 2000, 47 (36) :1654-1658. [10] XU JY, YI L, RAN CX, et al. Evaluation of diagnostic value of sera AFP for primiry liver cancer[J]. Chongqing Med J, 2009, 38 (1) :51-52, 55. (in Chinese) 徐建业, 易玲, 冉崇新, 等.血清甲胎蛋白对原发性肝癌诊断值的探讨[J].重庆医学, 2009, 38 (1) :51-52, 55. [11] BRUIX J, SHERMAN M. Management of hepatocellular carcinoma:An update[J]. Hepatology, 2011, 53 (3) :1020-1022. [12] LI QR, JI SD. Application of multiple tumor marker protein chip in healthy screening of old people and its clinical significance[J]. J Jilin Univ:Med Edit, 2016, 42 (3) :535-540. (in Chinese) 李清茹, 季顺东.多肿瘤标志物蛋白芯片检测在老年人健康体检中的应用价值及其临床意义[J].吉林大学学报:医学版, 2016, 42 (3) :535-540. [13] CHANG TS, WU YC, TUNG SY, et al. Corrigendum:Alpha-Fetoprotein measurement benefits hepatocellular carcinoma surveillance in patients with cirrhosis[J]. Am J Gastroenterol, 2016, 111 (11) :1668. [14] LAI BY, LI F. Comparison of the application value of CT and B ultrasound in the initial diagnosis of primary hepatic carcinoma[J].Chin J CT MRI, 2016, 14 (4) :71-73. (in Chinese) 来炳岩, 李芬. CT与B超在原发性肝癌首诊中应用价值对比[J].中国CT和MRI杂志, 2016, 14 (4) :71-73. 期刊类型引用(22)
1. 李玮,王雯,齐梦剑,宋研,张东,董明明,王海久,樊海宁,王志鑫. 肝癌合并门静脉癌栓局部治疗进展. 中国实用外科杂志. 2023(05): 591-596 . 百度学术
2. 柳彬,李志颖. 调强放疗联合肝动脉化疗栓塞术治疗原发性肝癌患者的效果. 中国民康医学. 2022(03): 30-32 . 百度学术
3. 马俊琴,凌小冬. 放射治疗联合肝动脉栓塞化疗治疗肝癌伴门静脉下腔静脉癌栓的近期疗效及对患者生存期的影响. 临床合理用药杂志. 2022(17): 175-178 . 百度学术
4. 吴娟,郭霞,林素英. 门静脉支架联合~(125)I粒子条+TACE治疗肝癌伴门静脉癌栓的护理探讨. 中外医学研究. 2021(08): 97-99 . 百度学术
5. 谢雅萍,苏铭羽,陈媛媛. 基于中医理论的情志护理对行肝动脉插管灌注化疗栓塞术肝癌患者的影响. 齐鲁护理杂志. 2021(11): 139-141 . 百度学术
6. 王功夏. CT导引下微波刀治疗肝癌疗效评价. 实用中西医结合临床. 2021(04): 45-46 . 百度学术
7. 张俊鹏,李琮宇,刘玉森,李拓,蒋蕾. 两种方法治疗肝癌并门静脉癌栓患者的microRNA-363水平变化及疗效对比. 中国现代医学杂志. 2021(16): 22-27 . 百度学术
8. 田希凤. IMRT联合TACE治疗原发性肝癌合并门静脉癌栓患者的临床疗效. 国际医药卫生导报. 2021(20): 3223-3226 . 百度学术
9. 曾宇,李珉. 探讨胆道支架联合~(125)Ⅰ粒子植入术治疗肝门区肿瘤合并梗阻性黄疸的疗效. 中国医疗器械信息. 2020(02): 86+124 . 百度学术
10. 吕晓雯,王甦. 肝癌合并门静脉癌栓的治疗进展. 医学理论与实践. 2020(05): 715-717 . 百度学术
11. 杜品清,刘云国,王东,黎庭贵,余建群. 载药微球经导管肝动脉化疗栓塞术治疗原发性肝癌患者的疗效及对血清胎盘生长因子、异常凝血酶原水平的影响. 癌症进展. 2020(13): 1358-1362 . 百度学术
12. 郑重,刘乔. 原发性肝癌合并门静脉癌栓的综合介入治疗效果. 中国继续医学教育. 2020(27): 134-137 . 百度学术
13. 刘明强. TACE联合门静脉腔内治疗技术对肝癌门静脉癌栓的疗效分析. 基层医学论坛. 2020(28): 4061-4062 . 百度学术
14. 张政,朱佳浩,朱谌芮,孙佳星. 亚低温对SD大鼠放射性肝损伤的保护作用. 临床和实验医学杂志. 2020(19): 2025-2029 . 百度学术
15. 吴建男. 肝动脉介入栓塞治疗肝癌合并门静脉瘤栓50例效果观察. 中国基层医药. 2020(23): 2830-2834 . 百度学术
16. 蔡联明,曾红学,王琪,陈爱林. 肝动脉热灌注化疗栓塞联合~(125)I放射粒子植入治疗原发性肝癌的临床疗效研究. 现代诊断与治疗. 2020(23): 3760-3762 . 百度学术
17. 李梦轩,阳丹才让,张灵强,李小雯,赵明恩,樊海宁. 浅析碘-125粒子组织间近距离放射治疗肝癌的进展. 临床医学研究与实践. 2019(01): 193-195 . 百度学术
18. 周凡,赵倩,徐浩,祖茂衡,林佳,张文耀,马雷,许伟. TACE联合~(125)I放射性粒子植入治疗原发性肝癌合并门静脉癌栓的荟萃分析. 介入放射学杂志. 2019(03): 268-275 . 百度学术
19. 惠海. 超选择介入栓塞治疗对肝癌合并门静脉癌栓的临床有效率分析. 临床医药文献电子杂志. 2019(52): 39-40 . 百度学术
20. 郑慧珂,孙昳,张丽. 原发性肝癌合并门静脉癌栓的综合介入治疗的临床效果观察. 黑龙江医药科学. 2019(04): 167-168 . 百度学术
21. 朱中博,钱建升,杨硕,李康乐,窦建卫. 不同剂量~(125)I粒子植入对人乳腺癌裸鼠荷瘤增殖的抑制作用及其机制. 吉林大学学报(医学版). 2019(06): 1305-1309 . 百度学术
22. 贾忠义,胡瑞峰. 放射介入栓塞化疗对肝癌合并门静脉癌栓治疗的疗效观察. 中西医结合心血管病电子杂志. 2018(11): 165 . 百度学术
其他类型引用(9)
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