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AFP’s Value to the Diagnosis of Hepatocellular Carcinoma and Its Related Factors

Author: HouJie
Tutor: GaoPuJun
School: Jilin University
Course: Clinical
Keywords: Alpha-fetoprotein Hepatocllular Carcinoma Diagnosis Related factors
CLC: R735.7
Type: Master's thesis
Year: 2013
Downloads: 65
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Abstract


Background:Hepatocellular carcinoma(HCC) is one of the most commonmalignant tumors,with high incidence and poor prognosis.Serumalpha-fetoprotein (AFP) is the only widely used tumor marker in thediagnosis of HCC.And it is a non-invasive diagnostic method whichmakes doctors dependent on this important indicator.The regulation ofHCC clinical diagnosis and staging of standard in China has set AFP>400ng/ml for diagnostic threshold.This standard is a no evidence-based basis,and according to it,the sensitivity is low and the rate of missed diagnosisis high.At present,AFP best threshold results for the diagnosis of HCC athome and abroad is still controversial.In addition, studies about thefactors influencing AFP’rise do not have a unified view.So to evaluatethe diagnostic value of AFP and AFP related factors again is verymeaningful.Objective:To evaluate the AFP best diagnostic threshold, and provide referencefor our hospital clinical medical workers and for our revision of HCCdiagnosis standard; to compare the relationship of AFP levels and HCCpatients’ gender, age,HBsAg,HBV-DNA loads,HCV antibody,HCV-RNAloads,AST,ALT,GGT,Child-Pugh grading,classification of tumor size,tumor number, portal thrombosis and BCLC staging.Methods:Collect448patients with HCC and560patients with hepatitis andcirrhosis of the liver in Bethune First Hospital of Ji Lin University from January in2010to December in2010,all from Ji Lin Province Area.Record AFP value of hepatitis, liver cirrhosis and HCC patients. Cut-offvalues of AFP are divided into10sequent levels. Calculate the sensitivity,specificity, accuracy, positive likelihood ratio, negative likelihood ratioand diagnostic odds ratio. The working curve drawing subjects (ROC) isused to determine the best diagnostic threshold; Record sex,age,HBsAg,HBV-DNA loads,HCV antibody,AST,ALT,GGT,albumin,prothrombintime, total bilirubin, extent of ascites and hepatic encephalopathy, tumorsize and number, patients’ physical activity status in patients of HCC.AFP concentration can be divided into normal group (7ng/ml or less) andelevated group (more than7ng/ml),to compare AFP level with gender,age,HBsAg,HBV-DNA loads, HCV antibody,HCV-RNA loads, AST,ALT,GGT,Child-Pugh grading, classification of tumor size, tumor number ofsingle lesions,portal thrombosis and BCLC stage.Results:1.When the AFP cut-off value is7ng/ml, the sensitivity ofdiagnosing HCC is the highest (72.2%), while specific degree is thelowest (32.14%); If the cut-off value is20ng/ml, the sensitivity andspecificity was53.57%,50.7%; When the cut-off value is400ng/ml, ithas the lowest sensitivity (20.54%) and the highest specific degree(96.43%); As to300ng/ml for the cut-off value, the sum of specificityand sensitivity is the largest.So is the area under the ROC curve (0.575).2.HCC patients’gender, age, HBV-DNA loads,HCV antibody,HCV-RNA loads,AST,ALT,GGT,Child-Pugh grading,tumors size insingle lesion has no significant difference in AFP two groups.Astatistically significant correlation was observed with respect toHBsAg,single and multiple tumors, portal thrombosis and the BCLCstaging in the AFP two groups. Conclusion:1, AFP equaling to300ng/ml is the best threshold value fordiagnosis of HCC.2, AFP level has no relation with gender, age, HBV-DNA loads,HCV antibody,HCV-RNA loads,ALT,AST,GGT,the Child-Pughgrading, and the size of the tumors in HCC patients.3, For HCC,the patients with hepatitis B virus infection,multipletumor,portal thrombosis and in later BCLC stage(B+C) have higherpercentage of elevated AFP.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Liver tumors
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