Combined use of AFP, PIVKA-II, and AFP-L3 as tumor markers enhances diagnostic accuracy for hepatocellular carcinoma in cirrhotic patients.

Abstract

OBJECTIVE:

As data on the effectiveness of tumor markers in detecting hepatocellular carcinoma (HCC) in cirrhotic patients are limited, we investigated the diagnostic accuracy of alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVKA-II), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3).

MATERIAL AND METHODS:

This retrospective study enrolled 361 cirrhotic patients with HCC, and 276 cirrhotic patients without HCC occurrence.

RESULTS:

Most patients were men (n = 431, 67.7%); the median age was 57.0 years. The main etiology of chronic liver disease was chronic hepatitis B (n = 467, 73.3%). The sensitivity and specificity of combined three biomarkers was 87.0 and 60.1% in overall HCC, and 75.7 and 60.1% in early HCC, respectively (cutoff: 20 ng/mL for AFP, 40 mAU/mL for PIVKA-II, and 5% for AFP-L3). The area under the receiver operating characteristic curve (AUROC) for HCC diagnosis was 0.765 (95% confidence interval [CI], 0.728-0.801) for AFP; 0.823 (95% CI, 0.791-0.854) for PIVKA-II; and 0.755 (95% CI, 0.718-0.792) for AFP-L3. The AUROC for early HCC diagnosis was 0.754 (95% CI, 0.691-0.816) for AFP, 0.701 (95% CI, 0.630-0.771) for PIVKA-II, and 0.670 (95% CI, 0.596-0.744) for AFP-L3. Combining the three tumor markers increased the AUROC to 0.877 (95% CI, 0.851-0.903) for HCC diagnosis, and 0.773 (95% CI, 0.704-0.841) for early HCC diagnosis.

CONCLUSION:

Diagnostic accuracy improved upon combining the AFP, PIVKA-II, and AFP-L3 tumor markers compared to each marker alone in detecting HCC and early HCC in cirrhotic patients.

• Authors: Tae Seop Lim, Do Young Kim, Kwang-Hyub Han, Hyon-Suk Kim, Seung Hwan Shin, Kyu Sik Jung, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn
• Journal: Scandinavian journal of gastroenterology (Scand J Gastroenterol) Vol. 51 Issue 3 Pg. 344-53 (03 2016) ISSN: 1502-7708 [Electronic] England
• PMID: 26340708 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Biomarkers, Tumor
• Plant Lectins
• Protein Isoforms
• Protein Precursors
• alpha-Fetoproteins
• lentil lectin
• acarboxyprothrombin
• Prothrombin

Topics

• Aged
• Area Under Curve
• Biomarkers (blood)
• Biomarkers, Tumor (blood, immunology)
• Carcinoma, Hepatocellular (blood, diagnosis, virology)
• Female
• Hepatitis B, Chronic (complications)
• Hepatitis C, Chronic (complications)
• Humans
• Liver Cirrhosis (virology)
• Liver Neoplasms (blood, diagnosis, virology)
• Male
• Middle Aged
• Plant Lectins (immunology)
• Protein Isoforms (blood)
• Protein Precursors (blood)
• Prothrombin
• ROC Curve
• Retrospective Studies
• alpha-Fetoproteins (immunology, metabolism)