Value of combined measurement of serum alpha-fetoprotein, Dickkopf-1, and cytoskeleton-associated protein 4 in diagnosis of hepatocellular carcinoma

Objective To investigate the value of combined measurement of serum alpha-fetoprotein (AFP) , Dickkopf-1 (DKK1) , and cytoskeleton-associated protein 4 (CKAP4) in the diagnosis of hepatocellular carcinoma (HCC) . Methods A total of 122 patients with HCC (76 patients in the early stage) , 152 patients with liver cirrhosis, and 105 patients with chronic hepatitis B, who were admitted to The First Affiliated Hospital of Soochow University from January 2013 to December 2017, were enrolled, and 101 individuals who underwent physical examination during the same period of time were enrolled as healthy control group. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between multiple groups. A binary logistic regression analysis was used to obtain the new variable of predicted probability, and the receiver operating characteristic (ROC) curve analysis was performed for each index and predicted probability to investigate the area under the ROC curve (AUC) , sensitivity, and specificity of the three indices used alone or in combination. Results The HCC group had significantly higher serum levels of AFP, DKK1, and CKAP4 than the liver cirrhosis group, the chronic hepatitis B group, and the healthy control groups (F = 121. 618, 84. 559, and 91. 769, P < 0. 001) . The combination of AFP, DKK1, and CKAP4 had an AUC of 0. 967 (95% confidence interval [CI]: 0. 950-0. 984) , a sensitivity of 0. 869, and a specificity of 0. 980, which were significantly higher than the AUCs, sensitivities, and specificities of the three indices used alone (all P <0. 05) . The combination of the three indices had an AUC of 0. 965 (95% CI: 0. 942-0. 988) , a sensitivity of 0. 868, and a specificity of0. 980 in the diagnosis of early-stage HCC, which were significantly higher than the AUCs, sensitivities, and specificities of the three indices used alone (all P < 0. 05) . Conclusion Combined measurement of serum AFP, DKK1, and CKAP4 improves the accuracy, sensitivity, and specificity of HCC diagnosis and thus has an important clinical value in the screening for and early diagnosis of HCC.