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Zhang L, Li S, Zhang D, Yin C, Wang Z, Chen R, Cheng N, Bai Y. Value of GPR, APPRI and FIB-4 in the early diagnosis of hepatocellular carcinoma: a prospective cohort study. Jpn J Clin Oncol 2024; 54:129-136. [PMID: 37869774 DOI: 10.1093/jjco/hyad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE There is an urgent need for novel biomarkers that are inexpensive, effective and easily accessible to complement the early diagnosis of hepatocellular carcinoma. This study aimed to analyze the relationship between serum gamma-glutamate-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index, fibrosis index based on four factors and the risk of hepatocellular carcinoma, and to determine the optimal cut-offs for predicting hepatocellular carcinoma. METHODS Based on a prospective cohort study, 44 215 participants who were cancer-free at baseline (2011-13) were included in the study. Cox proportional hazard models and receiver operating characteristics curves were used to analyze the diagnostic value and optimal cut-off value of gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors in predicting hepatocellular carcinoma patients. RESULTS Gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors can be used as early independent predictors of hepatocellular carcinoma risk. The risk of hepatocellular carcinoma in the fourth quantile of gamma-glutamyl-transpeptidase to platelet ratio and alkaline phosphatase-to-platelet ratio index was 4.04 times (hazard ratio = 4.04, 95% confidence interval: 2.09, 7.80) and 2.59 times (hazard ratio = 2.59, 95% confidence interval: 1.45, 4.61), respectively, compared with the first quantile. With fibrosis index based on four factors first quantile as a reference, fibrosis index based on four factors fourth quantile had the highest risk (hazard ratio = 18.58, 95% confidence interval: 7.55, 45.72). Receiver operating characteristic results showed that fibrosis index based on four factors had a stronger ability to predict the risk of hepatocellular carcinoma (area under curve = 0.81, 95% confidence interval: 0.80, 0.81), and similar results were shown for gender stratification. In the total population, the optimal cut-off values of gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors were 0.208, 0.629 and 1.942, respectively. CONCLUSIONS Gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors were independent predictors of hepatocellular carcinoma risk. Amongst them, fibrosis index based on four factors shows a stronger predictive ability for hepatocellular carcinoma risk, and gamma-glutamyl-transpeptidase to platelet ratio and alkaline phosphatase-to-platelet ratio index can be used as complementary indicators.
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Affiliation(s)
- Lizhen Zhang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Siyu Li
- Department of Epidemiology, Baotou Medical College, Baotou, China
| | - Desheng Zhang
- Jinchuan Group Co., LTD, Jinchuan Company Staff Hospital, Jinchang, China
| | - Chun Yin
- Jinchuan Group Co., LTD, Jinchuan Company Staff Hospital, Jinchang, China
| | - Zhongge Wang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ruirui Chen
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ning Cheng
- College of Basic Medicine, Lanzhou University, Lanzhou, China
| | - Yana Bai
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
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Song H, Wang J, Zhang H, Wu Y, Wang K, Wang X, Xu X. Combination of serum alpha-fetoprotein, PIVKA-Ⅱ and glypican-3 in diagnosis of hepatocellular carcinoma: a meta-analysis. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024; 53:131-139. [PMID: 38310085 PMCID: PMC10945496 DOI: 10.3724/zdxbyxb-2023-0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES To assess the value of serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) and glypican-3 (GPC-3) in the diagnosis of hepatocellular carcinoma (HCC). METHODS Studies of AFP, PIVKA-Ⅱ, GPC-3 or in combination for the diagnosis of HCC since 2002 were searched in PubMed, Web of Science and Embase databases. The literature was screened according to the inclusion and exclusion criteria, the quality of the included articles was evaluated by QUADAS checklist, and relevant data were extracted by Meta DiSc, Review Manager 5.4 and Stata 15.1. The diagnostic values of AFP, PIVKA-Ⅱ and GPC-3 alone or in combination for HCC were assessed with receiver operating characteristic (ROC) curve. RESULTS A total of 32 articles were included in the study. Meta-analysis showed that when a single marker was used to diagnose HCC, the area under the ROC curve (AUC) of PIVKA-Ⅱ was the highest (0.88, 95%CI: 0.85-0.91), followed by GPC-3 and AFP. The AUC of combination of serum markers was higher than that of a single marker, and the AUC of PIVKA-Ⅱ combined with GPC-3 was the highest (0.90, 95%CI: 0.87-0.92). When a single marker was used for diagnosis, the sensitivity of PIVKA-Ⅱ and GPC-3 were relatively high (0.75 and 0.76), while the specificity of PIVKA-Ⅱ (0.88) and AFP (0.87) were higher than that of GPC-3 (0.81). The sensitivity of the combination of serum markers was higher than that of a single marker, while the specificity was not significantly improved. When a single marker is used to diagnose HCC, the diagnostic odds ratio (DOR) of PIVKA-Ⅱ was the highest (22, 95%CI: 13-36), followed by GPC-3 and AFP. The DOR of the combination of two markers in the diagnosis of HCC was higher than that of a single marker, and the DOR of AFP combined with GPC-3 was the highest (25, 95%CI: 9-67). The DOR of the combination of the three markers was significantly reduced to 10 (95%CI: 7-45). CONCLUSIONS When a single marker is used, PIVKA-Ⅱ has a higher diagnostic value for HCC. The combination of two markers can significantly improve the diagnostic sensitivity, and AFP combined with PIVKA-Ⅱ is recommended for the diagnosis of HCC. The combination of all three markers failed to further improve the diagnostic value.
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Affiliation(s)
- Hongliang Song
- The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China.
- Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310003, China.
| | - Jianguo Wang
- The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
- Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310003, China
| | - Hui Zhang
- The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
- Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310003, China
| | - Yongfeng Wu
- Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310003, China
| | - Kai Wang
- The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China.
- Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310003, China.
| | - Xiaobo Wang
- Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310003, China.
| | - Xiao Xu
- Zhejiang Provincial Key Laboratory of Integrated Oncology and Intelligent Medicine, Hangzhou 310003, China.
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Kobeissy A, Merza N, Al-Hillan A, Boujemaa S, Ahmed Z, Nawras M, Albaaj M, Dahiya DS, Alastal Y, Hassan M. Protein Induced by Vitamin K Absence or Antagonist-II Versus Alpha-Fetoprotein in the Diagnosis of Hepatocellular Carcinoma: A Systematic Review With Meta-Analysis. J Clin Med Res 2023; 15:343-359. [PMID: 37575350 PMCID: PMC10416192 DOI: 10.14740/jocmr4951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/09/2023] [Indexed: 08/15/2023] Open
Abstract
Background Protein induced by vitamin K absence or antagonist-II (PIVKA-II) and α-fetoprotein (AFP) are promising tumor markers for the diagnosis of hepatocellular carcinoma (HCC). Yet, their diagnostic performance differs throughout HCC investigations. The aim of this meta-analysis was to assess the effectiveness of PIVKA-II and AFP in the diagnosis of HCC. Methods A systematic literature search was performed to identify relevant studies from eight databases, which were published up to February 2023, in order to compare the diagnostic performance of PIVKA-II and AFP for HCC. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic (SROC) curve was performed to assess the diagnostic accuracy of each biomarker. Results Fifty-three studies were identified. The pooled sensitivity (95% confidence interval (CI)) of PIVKA-II and AFP was 0.71 (0.70 - 0.72) and 0.64 (0.63 - 0.65), respectively in diagnosis of HCC, and the corresponding pooled specificity (95% CI) was 0.90 (0.89 - 0.90) and 0.87 (0.87 - 0.88), respectively. The area under the ROC curve (AUC) of PIVKA-II and AFP was 0.89 (0.88 - 0.90) and 0.78 (0.77 - 0.79), respectively. Subgroup analysis demonstrated that PIVKA-II presented higher AUC values compared to AFP in terms of ethnic group (African, European, Asian, and American patients), etiology (mixed-type HCC, hepatitis C virus (HCV)-related, and hepatitis B virus (HBV)-related) and sample size of cases (≤ 100 and > 100). Conclusion This study reveals that PIVKA-II is a promising biomarker for identifying and tracking HCC, exhibiting greater accuracy than AFP. Our findings indicate that PIVKA-II outperforms AFP in detecting HCC across diverse racial groups and sample sizes, as well as in cases of HBV-related, HCV-related, or mixed-etiology HCC.
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Affiliation(s)
- Abdallah Kobeissy
- Department of Gastroenterology, The University of Toledo, Toledo, OH, USA
| | - Nooraldin Merza
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Alsadiq Al-Hillan
- Gastroenterology Department, Corewell Health/Willam Beaumont University Hospital, Royal Oak, MI, USA
| | - Safa Boujemaa
- Biotechnology Development, Institute Pasteur De Tunis, Universite De Tunis El Manar, Tunis, Tunisia
| | - Zohaib Ahmed
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Mohamad Nawras
- The University of Toledo, College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mohammed Albaaj
- Department of Pharmacology and Experimental Therapeutics, University of Toledo, Toledo, OH, USA
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Yaseen Alastal
- Department of Gastroenterology, The University of Toledo, Toledo, OH, USA
| | - Mona Hassan
- Department of Gastroenterology, The University of Toledo, Toledo, OH, USA
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Diagnostic Performance of Extrahepatic Protein Induced by Vitamin K Absence in the Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13050816. [PMID: 36899960 PMCID: PMC10001363 DOI: 10.3390/diagnostics13050816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES the early diagnosis of hepatocellular carcinoma (HCC) benefits from the use of alpha-fetoprotein (AFP) together with imaging diagnosis using abdominal ultrasonography, CT, and MRI, leading to improved early detection of HCC. A lot of progress has been made in the field, but some cases are missed or late diagnosed in advanced stages of the disease. Therefore, new tools (serum markers, imagistic technics) are continually being reconsidered. Serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist II (PIVKA II) diagnostic accuracy for HCC (global and early disease) has been investigated (in a separate or cumulative way). The purpose of the present study was to determine the performance of PIVKA II compared to AFP. MATERIALS AND METHODS systematic research was conducted in PubMed, Web of Science, Embase, Medline and the Cochrane Central Register of Controlled Trials, taking into consideration articles published between 2018 and 2022. RESULTS a total number of 37 studies (5037 patients with HCC vs. 8199 patients-control group) have been included in the meta-analysis. PIVKA II presented a better diagnostic accuracy in HCC diagnostic vs. alpha-fetoprotein (global PIVKA II AUROC 0.851 vs. AFP AUROC 0.808, respectively, 0.790 vs. 0.740 in early HCC cases). The conclusion from a clinical point of view, concomitant use of PIVKA II and AFP can bring useful information, added to that brought by ultrasound examination.
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Eguchi A, Iwasa M, Tamai Y, Yamada M, Okuno K, Shigefuku R, Yoshikawa K, Tempaku M, Sakaguchi K, Tanaka H, Sugimoto K, Kobayashi Y, Yamaguchi T, Nakagawa H. The prognostic potential of fragmented CK18 serum levels in HCC patients reflecting disease progression and overall hepatocyte damage. Front Oncol 2022; 12:993705. [PMID: 36081568 PMCID: PMC9446083 DOI: 10.3389/fonc.2022.993705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background Fragmented cytokeratin 18 (fCK18) is released from damaged hepatocytes undergoing apoptosis and is recognized as a liver condition biomarker. We have developed a highly sensitive serum fCK18 CLEIA and reported that serum levels of this caspase-derived protein were significantly associated with hepatocyte ballooning, thus assisting in the accurate diagnosis of nonalcoholic steatohepatitis (NASH). We aim to investigate serum fCK18 levels in a variety of chronic liver diseases and to explore its potential as a prognostic marker of survival in hepatocellular carcinoma (HCC) patients. Methods Serum fCK18 levels were measured using a highly sensitive CLEIA in 497 chronic liver disease patients (297 outpatients and 200 hospitalized with HCC). Results In 497 chronic liver disease patients, serum fCK18 levels were significantly correlated with overall liver condition, including ALT, FIB-4 index and albumin-bilirubin (ALBI) score and were significantly increased in patients with HCC. In 200 HCC patients, serum fCK18 levels were significantly correlated with alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP), and were significantly associated with HCC stage, whereas FIB-4 index and ALBI score were not changed based on HCC stage. The Survival group had significantly lower levels of serum fCK18, AFP, DCP, FIB-4 index and ALBI score. A ROC analysis yield area under the curve (AUC) value of 0.728 for serum fCK18 is a significantly high value when compared to AUC measurements for other factors. Notably, AUROC values for serum fCK18 levels were constant in the short- and long-term by time-dependent ROC analysis for the prediction of HCC patient survival. HCC patients with serum fCK18 measured at < 1.15 ng/mL, AFP < 7.7 ng/mL, DCP < 133 mAU/mL, ALBI score < -2.97 or FIB-4 index < 6.4 had significantly longer rates of survival when compared to patients with values exceeding these thresholds. Serum fCK18 (HR, 3.5; P < 0.0001), DCP (HR, 3.2; P < 0.0001) and Barcelona Clinic Liver Cancer (BCLC) (HR, 2.4; P = 0.001) values were independent predictors of patient survival. [Conclusion] Serum fCK18 levels reflect overall liver function, the level of liver fibrosis and the progression of HCC, and are a potential predictor of survival in HCC patients.
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Affiliation(s)
- Akiko Eguchi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
- *Correspondence: Akiko Eguchi,
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasuyuki Tamai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Minori Yamada
- Bio-Reagent Material Development, Bio-Diagnostic Reagent Technology Center, Sysmex Corporation, Kobe, Japan
| | - Koji Okuno
- Scientific Affairs, Sysmex Corporation, Kobe, Japan
| | - Ryuta Shigefuku
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kyoko Yoshikawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Mina Tempaku
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Koji Sakaguchi
- Bio-Reagent Material Development, Bio-Diagnostic Reagent Technology Center, Sysmex Corporation, Kobe, Japan
| | - Hideaki Tanaka
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kazushi Sugimoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshinao Kobayashi
- Center for Physical and Mental Health, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Tetsuji Yamaguchi
- Manufacturing Technology Development 1, Reagent Production, Sysmex Corporation, Kobe, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
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Nguyen HB, Le XTT, Nguyen HH, Vo TT, Le MK, Nguyen NT, Do-Nguyen TM, Truong-Nguyen CM, Nguyen BST. Diagnostic Value of hTERT mRNA and in Combination With AFP, AFP-L3%, Des-γ-carboxyprothrombin for Screening of Hepatocellular Carcinoma in Liver Cirrhosis Patients HBV or HCV-Related. Cancer Inform 2022; 21:11769351221100730. [PMID: 35614962 PMCID: PMC9125073 DOI: 10.1177/11769351221100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Diagnosis of hepatocellular carcinoma (HCC) in early-stage, to give an effective treatment option and improve quality of life for cancer patients, is an important medical mission globally. Combination of AFP with some biomarkers may be more supportive in both diagnosis and screening of HCC, but the range value of these markers can be applied as daily markers were unclearly. In some studies, human telomerase reverse transcriptase (hTERT mRNA) was reported as an advantage marker to diagnose cancer. The present study identified serum of 340 patients that were infected chronic hepatitis B virus or hepatitis C virus and divided in 2 groups including Hepatocellular carcinoma (HCC) and liver cirrhosis (LC) to measure their values of hTERT mRNA, AFP, AFP-L3%, and DCP, as well as combination of them. As a result, the concentration of hTERT mRNA, AFP, AFP-L3%, and DCP in HCC groups were significantly higher than that in LC group (P < .01). For detecting HCC, hTERT mRNA had sensitivity of 88% and specificity of 96% (at the cutoff value of 31.5 copies/mL), AFP sensitivity of 73% and specificity of 92% (at the cutoff value of 5.1 ng/mL), AFP-L3% sensitivity of 69% and specificity of 90% (at the cutoff value of 1.05%), DCP sensitivity of 82% and specificity of 92% (at the cutoff value of 29.01 mAU/mL). The largest area under the curve (AUC) of combination hTERT mRNA with DCP was 0.932 (sensitivity of 98.2% and specificity of 88.2%). New combination of DCP with hTERT mRNA gave a useful choice for screening of HCC in chronic HBV or HCV patients associated liver cirrhosis.
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Affiliation(s)
- Hoang Bac Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Xuan-Thao Thi Le
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Huy Huu Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Thanh Thanh Vo
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Minh Khoi Le
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Ngan Trung Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Thien Minh Do-Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Cong Minh Truong-Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
| | - Bang-Suong Thi Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; University Medical Center, Ho Chi Minh City, Viet Nam
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Gil-Gómez A, Rojas Á, Liu CH, Gallego-Duran R, Muñoz-Hernandez R, Fassina G, Pontisso P, Ampuero J, Romero-Gómez M. Combination of squamous cell carcinoma antigen immunocomplex and alpha-fetoprotein in mid- and long-term prediction of hepatocellular carcinoma among cirrhotic patients. World J Gastroenterol 2021; 27:8343-8356. [PMID: 35068873 PMCID: PMC8717022 DOI: 10.3748/wjg.v27.i48.8343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/27/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The combination of alpha-fetoprotein (AFP) and squamous cell carcinoma antigen immunocomplex (SCCA-IgM) have been proposed for its use in the screening of hepatocellular carcinoma (HCC). Current screening programs for all cirrhotic patients are controversial and a personalized screening is an unmet need in the precision medicine era.
AIM To determine the role of the combination of SCCA-IgM and AFP in predicting mid- and long-term appearance of HCC.
METHODS Two-hundred and three cirrhotic patients (Child A 74.9%, B 21.2%, C 3.9%) were followed-up prospectively every six months to screen HCC by ultrasound and AFP according to European Association for the Study of the Liver guidelines. The estimation cohort was recruited in Italy (30.5%; 62/203) and validation cohort from Spain (69.5%; 141/203). Patients underwent to evaluate SCCA-IgM by enzyme-linked immunosorbent assay (Hepa-IC, Xeptagen, Italy) and AFP levels at baseline. Patients were followed-up for 60 mo, being censored at the time of the appearance of HCC.
RESULTS There were 10.8% and 23.1% of HCC development at two- and five-years follow-up. Patients with HCC showed higher levels of SCCA-IgM than those without it (425.72 ± 568.33 AU/mL vs 195.93 ± 188.40 AU/mL, P = 0.009) during the five-year follow-up. In multivariate analysis, after adjusting by age, sex, aspartate transaminase and Child-Pugh, the following factors were independently associated with HCC: SCCA-IgM [Hazard ratio (HR) = 1.001, 95%CI: 1.000-1.002; P = 0.003], AFP (HR = 1.028, 95%CI: 1.009-1.046; P = 0.003) and creatinine (HR = 1.564 95%CI: 1.151-2.124; P = 0.004). The log-rank test of the combination resulted in 7.488 (P = 0.024) in estimation cohort and 11.061 (P = 0.004) in the validation cohort, and a 100% of correctly classified rate identifying a low-risk group in both cohorts in the two-year follow-up.
CONCLUSION We have constructed a predictive model based on the combination of SCCA-IgM and AFP that provides a new HCC screening method, which could be followed by tailored HCC surveillance for individual patients, especially for those cirrhotic patients belonging to the subgroup identified as low-risk of HCC development.
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Affiliation(s)
- Antonio Gil-Gómez
- SeLiver Group, Institute of Biomedicine of Seville, Seville 41013, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid 28029, Spain
- Mucosal Immunity Lab, IRCCS Humanitas Research Hospital, Milan 20089, Italy
| | - Ángela Rojas
- SeLiver Group, Institute of Biomedicine of Seville, Seville 41013, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Chang-Hai Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610017, Sichuan Province, China
- State Key Laboratory of Biotherapy and Center of Infectious Diseases, West China Hospital, Chengdu 610017, Sichuan Province, China
| | - Rocio Gallego-Duran
- SeLiver Group, Institute of Biomedicine of Seville, Seville 41013, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Rocio Muñoz-Hernandez
- SeLiver Group, Institute of Biomedicine of Seville, Seville 41013, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid 28029, Spain
| | | | - Patrizia Pontisso
- Department of Clinical and Experimental Medicine, University of Padova, Padova 35123, Italy
| | - Javier Ampuero
- SeLiver Group, Institute of Biomedicine of Seville, Seville 41013, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid 28029, Spain
- UCM Digestive Diseases, Virgen del Rocío University Hospital, Seville 41014, Spain
| | - Manuel Romero-Gómez
- SeLiver Group, Institute of Biomedicine of Seville, Seville 41013, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid 28029, Spain
- UCM Digestive Diseases, Virgen del Rocío University Hospital, Seville 41014, Spain
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Hayashi M, Yamada S, Takano N, Okamura Y, Takami H, Inokawa Y, Sonohara F, Tanaka N, Shimizu D, Hattori N, Kanda M, Tanaka C, Nakayama G, Koike M, Kodera Y. Different Characteristics of Serum Alfa Fetoprotein and Serum Des-gamma-carboxy Prothrombin in Resected Hepatocellular Carcinoma. In Vivo 2021; 35:1749-1760. [PMID: 33910859 DOI: 10.21873/invivo.12434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Hepatocellular carcinoma (HCC) mainly develops in the damaged liver from hepatitis C virus (HCV) or hepatitis B virus (HBV) infection in Japan. On the other hand, the occurrence of HCCs derived from the liver without viral infection has recently been increasing. Our aim was to identify characteristics specific to HCCs with virus-infected liver (HCC-BC) or those with non-B- and non-C-infected liver (HCC-NBNC), Patients and Methods: We collected preoperative serum α-fetoprotein (AFP) and Des-Gamma-Carboxy Prothrombin (DCP), also known as PIVKA-II values from surgically resected HCC cases during 1994-2017 in our department. RESULTS Preoperative serum AFP values of HCC-BC cases (n=284) were higher compared to HCC-NBNC cases (n=88) (p=0.016), whereas serum DCP values of HCC-NBNC cases were higher compared to HCC-BC cases (p<0.001). Multivariable analyses indicated that abnormal serum AFP [hazard ratio (HR)=1.46, 95% conficdence interval (CI)=1.03-2.07, p=0.035) was one of the significant recurrence-free survival predictors of HCC-BC cases, while abnormal serum DCP (HR=4.99, 95%CI=1.91-13.01, p=0.001) was one of the significant recurrence-free survival predictors of HCC-NBNC cases. CONCLUSION HCC-NBNC cases have a different tumor marker profile from HCC-BC cases. Elevated DCP could be both a diagnostic and prognostic marker of HCC-NBNC patients.
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Affiliation(s)
- Masamichi Hayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;
| | - Nao Takano
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshikuni Inokawa
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fuminori Sonohara
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobutake Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dai Shimizu
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norifumi Hattori
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Goro Nakayama
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Koike
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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