中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 11
Nov.  2023
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(11): 2607-2613

Diagnostic efficacy of alpha-fetoprotein and alpha-fetoprotein L3% in hepatitis B virus-related early-stage hepatocellular carcinoma

DOI: 10.3969/j.issn.1001-5256.2023.11.014

  • Department of Infectious Diseases，The Third Affiliated Hospital of Sun Yat-Sen University，Guangzhou 510635，China

More Information
  • Corresponding author: ZHU Jianyun， 13719366255@139.com （ORCID： 0000-0002-2875-7932）
  • Received Date: 2023-02-24
  • Accepted Date: 2023-03-28
  • Published Date: 2023-11-28
    Abstract
  •   Objective  To investigate the diagnostic efficacy and optimal cut-off values of alpha-fetoprotein （AFP） and alpha-fetoprotein variant L3 （AFP-L3） in hepatitis B virus （HBV）-related early-stage hepatocellular carcinoma （HCC）.  Methods  A total of 1 080 patients with HBV-related HCC （HBV-HCC） who were diagnosed for the first time and not yet treated in The Third Affiliated Hospital of Sun Yat-Sen University from January 2019 to July 2022 were enrolled as HCC group in the study， among whom there were 620 patients with CNLC Ⅰ‍a-‍Ⅱ‍a HCC， and in addition， 346 patients with HBV-related chronic hepatitis B （CHB group） and 293 patients with HBV-related liver cirrhosis （LC group） were enrolled as controls. The diagnostic efficacy of AFP and AFP-L3% in screening for HBV-related early-stage HCC was analyzed， including sensitivity， specificity， and the area under the ROC curve （AUC）. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups； the Kruskal-Wallis H test was used for comparison between multiple groups， and the Bonferroni method was used for further comparison between two groups.  Results  The HCC group had significantly higher levels of AFP and AFP-L3% than the CHB group and the LC group （H=542.479 and 418.974， both P<0.001）. In early-stage HCC， AFP and AFP-L3% had an optimal cut-off value of 8.7 ng/mL and 5%， respectively， and AFP alone had the largest AUC of 0.816， with a sensitivity of 66.9% and a specificity of 85.1%. There was no significant difference in AUC between AFP-L3%+AFP and AFP alone （Z=0.609， P=0.543）， but both AFP-L3%+AFP and AFP alone had a significantly larger AUC than AFP-L3% alone （AFP vs AFP-L3%： Z=8.173， P<0.001； AFP+AFP-L3% vs AFP-L3%： Z=8.802， P<0.001）.  Conclusion  AFP has a good value and is superior to AFP-L3% in the diagnosis of HBV-related early-stage HCC， and the screening cut-off value of AFP should be lowered in order to improve the detection rate of early-stage HCC.

     

    • FullText(HTML)
  • loading
    • References(28)
  • [1]
    SUNG H, FERLAY J, SIEGEL RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71( 3): 209- 249. DOI: 10.3322/caac.21660.
    [2]
    ALLEMANI C, MATSUDA T, DI CARLO V, et al. Global surveillance of trends in cancer survival 2000-14(CONCORD-3): Analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J]. Lancet, 2018, 391( 10125): 1023- 1075. DOI: 10.1016/S0140-6736(17)33326-3.
    [3]
    TSILIMIGRAS DI, BAGANTE F, SAHARA K, et al. Prognosis after resection of Barcelona clinic liver cancer(BCLC) stage 0, A, and B hepatocellular carcinoma: A comprehensive assessment of the current BCLC classification[J]. Ann Surg Oncol, 2019, 26( 11): 3693- 3700. DOI: 10.1245/s10434-019-07580-9.
    [4]
    HEIMBACH JK, KULIK LM, FINN RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma[J]. Hepatology, 2018, 67( 1): 358- 380. DOI: 10.1002/hep.29086.
    [5]
    Professional Committee for Prevention and Control of Hepatobiliary and Pancreatic Diseases of Chinese Preventive Medicine Association; Professional Committee for Hepatology, Chinese Research Hospital Association; Chinese Society of Hepatology, Chinese Medical Association, et al. Guideline for stratified screening and surveillance of primary liver cancer(2020 edition)[J]. J Clin Hepatol, 2021, 37( 2): 286- 295. DOI: 10.3969/j.issn.1001-5256.2021.02.009.

    中华预防医学会肝胆胰疾病预防与控制专业委员会, 中国研究型医院学会肝病专业委员会, 中华医学会肝病学分会, 等. 原发性肝癌的分层筛查与监测指南(2020版)[J]. 临床肝胆病杂志, 2021, 37( 2): 286- 295. DOI: 10.3969/j.issn.1001-5256.2021.02.009.
    [6]
    TZARTZEVA K, OBI J, RICH NE, et al. Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis: A meta-analysis[J]. Gastroenterology, 2018, 154( 6): 1706- 1718.e1. DOI: 10.1053/j.gastro.2018.01.064.
    [7]
    SUGIYAMA H, TAKESHITA H, TACHibANA K, et al. Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein as a tumor marker in a patient with nonseminomatous germ cell tumor with normal alpha-fetoprotein level[J]. Clin Genitourin Cancer, 2020, 18( 3): e309- e311. DOI: 10.1016/j.clgc.2019.12.013.
    [8]
    Bureau of Medical Administration, National Health Commission of the People’s Republic of China. Guidelines for diagnosis and treatment of primary liver cancer in China(2019 edition)[J]. J Clin Hepatol, 2020, 36( 2): 277- 292. DOI: 10.3969/j.issn.1001-5256.2020.02.007.

    中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 临床胆病杂志, 2020, 36( 2): 277- 292. DOI: 10.3969/j.issn1001-5256.2020.02.007.
    [9]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2019)[J]. J Clin Hepatol, 2019, 35( 12): 2648- 2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35( 12): 2648- 2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [10]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001- 5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [11]
    WANG XP, WANG QX. Alpha-fetoprotein and hepatocellular carcinoma immunity[J]. Can J Gastroenterol Hepatol, 2018, 2018: 9049252. DOI: 10.1155/2018/9049252.
    [12]
    SAUZAY C, PETIT A, BOURGEOIS AM, et al. Alpha-foetoprotein(AFP): A multi-purpose marker in hepatocellular carcinoma[J]. Clin Chim Acta, 2016, 463: 39- 44. DOI: 10.1016/j.cca.2016.10.006.
    [13]
    SINGAL AG, HAALAND B, PARIKH ND, et al. Comparison of a multitarget blood test to ultrasound and alpha-fetoprotein for hepatocellular carcinoma surveillance: Results of a network meta-analysis[J]. Hepatol Commun, 2022, 6( 10): 2925- 2936. DOI: 10.1002/hep4.2045.
    [14]
    YI XY, YU S, BAO YX. Alpha-fetoprotein-L3 in hepatocellular carcinoma: A meta-analysis[J]. Clin Chim Acta, 2013, 425: 212- 220. DOI: 10.1016/j.cca.2013.08.005.
    [15]
    ZHOU JM, WANG T, ZHANG KH. AFP-L3 for the diagnosis of early hepatocellular carcinoma: A meta-analysis[J]. Medicine, 2021, 100( 43): e27673. DOI: 10.1097/MD.0000000000027673.
    [16]
    ZHANG ZG, ZHANG YY, WANG YY, et al. Alpha-fetoprotein-L3 and Golgi protein 73 may serve as candidate biomarkers for diagnosing alpha-fetoprotein-negative hepatocellular carcinoma[J]. Onco Targets Ther, 2016, 9: 123- 129. DOI: 10.2147/OTT.S90732.
    [17]
    CHOI JY, JUNG SW, KIM HY, et al. Diagnostic value of AFP-L3 and PIVKA-II in hepatocellular carcinoma according to total-AFP[J]. World J Gastroenterol, 2013, 19( 3): 339- 346. DOI: 10.3748/wjg.v19.i3.339.
    [18]
    STERLING RK, JEFFERS L, GORDON F, et al. Utility of Lens culinaris agglutinin-reactive fraction of α-fetoprotein and des-gamma-carboxy prothrombin, alone or in combination, as biomarkers for hepatocellular carcinoma[J]. Clin Gastroenterol Hepatol, 2009, 7( 1): 104- 113. DOI: 10.1016/j.cgh.2008.08.041.
    [19]
    CHOI J, KIM GA, HAN S, et al. Longitudinal assessment of three serum biomarkers to detect very early-stage hepatocellular carcinoma[J]. Hepatology, 2019, 69( 5): 1983- 1994. DOI: 10.1002/hep.30233.
    [20]
    LOK AS, STERLING RK, EVERHART JE, et al. Des-gamma-carboxy prothrombin and alpha-fetoprotein as biomarkers for the early detection of hepatocellular carcinoma[J]. Gastroenterology, 2010, 138( 2): 493- 502. DOI: 10.1053/j.gastro.2009.10.031.
    [21]
    MARRERO JA, FENG ZD, WANG YH, et al. Alpha-fetoprotein, des-gamma carboxyprothrombin, and lectin-bound alpha-fetoprotein in early hepatocellular carcinoma[J]. Gastroenterology, 2009, 137( 1): 110- 118. DOI: 10.1053/j.gastro.2009.04.005.
    [22]
    KUDO M, KAWAMURA Y, HASEGAWA K, et al. Management of hepatocellular carcinoma in Japan: JSH consensus statements and recommendations 2021 update[J]. Liver Cancer, 2021, 10( 3): 181- 223. DOI: 10.1159/000514174.
    [23]
    ZHANG JX, CHEN G, ZHANG P, et al. The threshold of alpha-fetoprotein(AFP) for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis[J]. PLoS One, 2020, 15( 2): e0228857. DOI: 10.1371/journal.pone.0228857.
    [24]
    LI B, ZHAO YY, DUAN Y, et al. Diagnostic value of alpha-fetoprotein heterogeneity L3 on early primary liver cancer[J/CD]. Chin J Liver Dis(Electronic Version), 2018, 10( 4): 7- 11. DOI: 10.3969/j.issn.1674-7380.2018.04.002.

    李贲, 赵莹莹, 段英, 等. 甲胎蛋白异质体L3对早期原发性肝癌的诊断价值[J/CD]. 中国肝脏病杂志(电子版), 2018, 10( 4): 7- 11. DOI: 10.3969/j.issn.1674-7380.2018.04.002.
    [25]
    TIAN Z, ZHANG JH. A threshold analysis of alpha-fetoprotein in diagnosis and screening of hepatocellular carcinoma[J]. J Clin Hepatol, 2018, 34( 11): 2352- 2355. DOI: 10.3969/j.issn.1001-5256.2018.11.016.

    田州, 张建淮. 甲胎蛋白诊断和筛查原发性肝癌的阈值分析[J]. 临床肝胆病杂志, 2018, 34( 11): 2352- 2355. DOI: 10.3969/j.issn.1001-5256.2018.11.016.
    [26]
    Chinese Society of Hepatology, Chinese Medical Association. Consensus on the secondary prevention for primary liver cancer(2021 edition)[J]. J Clin Hepatol, 2021, 37( 3): 532- 542. DOI: 10.3969/j.issn.1001-5256.2021.03.008.

    中华医学会肝病学分会. 原发性肝癌二级预防共识(2021年版)[J]. 临床肝胆病杂志, 2021, 37( 3): 532- 542. DOI: 10.3969/j.issn.1001-5256.2021.03.008.
    [27]
    CHEN SY, LI JH, TAN XD, et al. Clinical role of combining alpha-fetoprotein and lens culinaris agglutinin-reactive fraction of alpha-fetoprotein for hepatocellular carcinoma: Evidence from literature and an original study[J]. J Clin Lab Anal, 2020, 34( 7): e23262. DOI: 10.1002/jcla.23262.
    [28]
    GUAN GW, YAO MJ, QIAN XJ, et al. Value of combined measurement of alpha-fetoprotein and alpha-fetoprotein L3% in the diagnosis of hepatocellular carcinoma[J]. J Clin Hepatol, 2019, 35( 7): 1514- 1519. DOI: 10.3969/j.issn.1001-5256.2019.07.019.

    关贵文, 姚明解, 钱相君, 等. AFP和AFP-L3%联合检测在肝细胞癌诊断中的应用价值[J]. 临床肝胆病杂志, 2019, 35( 7): 1514- 1519. DOI: 10.3969/j.issn.1001-5256.2019.07.019.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(6)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (360) PDF downloads(43) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return