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Abstract：
OBJECTIVE: Measurements of α-fetoprotein (AFP) detect hepatocellular carcinoma (HCC) with low levels of sensitivity and specificity, and therefore are not recommended for use in liver cancer surveillance. However, AFP levels might accurately detect HCC in subgroups of patients. We performed a retrospective case-control study to identify features of patients with cirrhosis in whom levels of AFP correlated with HCC.
METHODS: We collected data from patients with cirrhosis, with (n = 452) or without (n = 676) HCC, diagnosed at Parkland Hospital in Dallas, Texas, from January 2005 through June 2012. We determined sensitivities and specificities with which different levels of AFP identified those with HCC; multivariate logistic regression was used to associate accurate identification of HCC with patient features (age, sex, race/ethnicity, alcohol intake, smoking, etiology of cirrhosis, presence of decompensation, and laboratory test results). We assessed the overall accuracy of these factors in detecting HCC using receiver operator characteristic curve analysis and the Delong method. We calculated levels of AFP that detect HCC with the highest levels of sensitivity and specificity in subgroups using receiver operator characteristic analysis.
RESULTS: The most common etiologies of cirrhosis were hepatitis C virus (HCV) infection (60%) and alcohol induced (22%). Nearly 11% of patients were human immunodeficiency virus (HIV)-positive. Levels of AFP greater than 20 ng/mL detected HCC with 70.1% sensitivity and 89.8% specificity. This AFP level identified patients with HCC with a c-statistic of 0.87 (95% confidence interval, 0.85-0.89); it was significantly more accurate in HCV-negative patients than in HCV-positive patients (c-statistic, 0.89 vs 0.83; P = .007). AFP levels of 59 ng/mL or greater most accurately detected HCC in patients with HCV-associated cirrhosis; levels of AFP of 11 ng/mL or greater accurately identified HCC in HCV-negative patients. The level of AFP identified early stage HCC with a c-statistic of 0.62 (95% confidence interval, 0.58-0.66), and had a significantly higher level of accuracy for HIV-positive patients than for HIV-negative patients (c-statistic, 0.81 vs 0.59; P < .001).
CONCLUSIONS: Based on a retrospective analysis of data from patients with cirrhosis, with or without HCC, AFP level most accurately detects HCC in patients without HCV infection. It detects HCC with a high level of accuracy in patients with cirrhosis and HIV infection.
METHODS: We collected data from patients with cirrhosis, with (n = 452) or without (n = 676) HCC, diagnosed at Parkland Hospital in Dallas, Texas, from January 2005 through June 2012. We determined sensitivities and specificities with which different levels of AFP identified those with HCC; multivariate logistic regression was used to associate accurate identification of HCC with patient features (age, sex, race/ethnicity, alcohol intake, smoking, etiology of cirrhosis, presence of decompensation, and laboratory test results). We assessed the overall accuracy of these factors in detecting HCC using receiver operator characteristic curve analysis and the Delong method. We calculated levels of AFP that detect HCC with the highest levels of sensitivity and specificity in subgroups using receiver operator characteristic analysis.
RESULTS: The most common etiologies of cirrhosis were hepatitis C virus (HCV) infection (60%) and alcohol induced (22%). Nearly 11% of patients were human immunodeficiency virus (HIV)-positive. Levels of AFP greater than 20 ng/mL detected HCC with 70.1% sensitivity and 89.8% specificity. This AFP level identified patients with HCC with a c-statistic of 0.87 (95% confidence interval, 0.85-0.89); it was significantly more accurate in HCV-negative patients than in HCV-positive patients (c-statistic, 0.89 vs 0.83; P = .007). AFP levels of 59 ng/mL or greater most accurately detected HCC in patients with HCV-associated cirrhosis; levels of AFP of 11 ng/mL or greater accurately identified HCC in HCV-negative patients. The level of AFP identified early stage HCC with a c-statistic of 0.62 (95% confidence interval, 0.58-0.66), and had a significantly higher level of accuracy for HIV-positive patients than for HIV-negative patients (c-statistic, 0.81 vs 0.59; P < .001).
CONCLUSIONS: Based on a retrospective analysis of data from patients with cirrhosis, with or without HCC, AFP level most accurately detects HCC in patients without HCV infection. It detects HCC with a high level of accuracy in patients with cirrhosis and HIV infection.
摘要：
目的：甲胎蛋白（AFP）检测肝细胞癌（HCC）的敏感性和特异性较低，因此不建议用于肝癌监测。然而,AFP水平可以准确检测患者亚组中的HCC。我们进行了一项回顾性病例对照研究，以确定AFP水平与HCC相关的肝硬化患者的特征。
方法：我们收集了肝硬化患者的数据，有（n=452）或没有（n=676）HCC，在达拉斯的帕克兰医院确诊,德州,从2005年1月到2012年6月。我们确定了不同水平的AFP识别HCC的敏感性和特异性；多变量逻辑回归用于将HCC的准确识别与患者特征（年龄，性别,种族/民族,酒精摄入量,吸烟,肝硬化的病因，代偿失调的存在，和实验室测试结果)。我们使用受试者操作员特征曲线分析和Delong方法评估了这些因素在检测HCC中的总体准确性。我们使用接收器操作员特征分析计算了亚组中灵敏度和特异性最高的AFP水平。
结果：肝硬化最常见的病因是丙型肝炎病毒（HCV）感染（60％）和酒精诱导（22％）。近11％的患者是人类免疫缺陷病毒（HIV）阳性。AFP水平大于20ng/mL检测HCC，敏感性为70.1％，特异性为89.8％。该AFP水平确定HCC患者的c统计量为0.87（95％置信区间，0.85-0.89）；HCV阴性患者的准确性明显高于HCV阳性患者（c统计量，0.89vs0.83；P=.007）。59ng/mL或更高的AFP水平在HCV相关肝硬化患者中最准确地检测到HCC;11ng/mL或更高的AFP水平在HCV阴性患者中准确地识别出HCC。AFP水平以0.62的c统计量识别早期HCC(95%置信区间，0.58-0.66),并且对HIV阳性患者的准确性水平明显高于HIV阴性患者（c统计量，0.81vs0.59；P<.001）。
结论：基于对肝硬化患者数据的回顾性分析，有或没有HCC，AFP水平最准确地检测没有HCV感染的患者的HCC。它在肝硬化和HIV感染患者中以高水平的准确性检测HCC。
方法：我们收集了肝硬化患者的数据，有（n=452）或没有（n=676）HCC，在达拉斯的帕克兰医院确诊,德州,从2005年1月到2012年6月。我们确定了不同水平的AFP识别HCC的敏感性和特异性；多变量逻辑回归用于将HCC的准确识别与患者特征（年龄，性别,种族/民族,酒精摄入量,吸烟,肝硬化的病因，代偿失调的存在，和实验室测试结果)。我们使用受试者操作员特征曲线分析和Delong方法评估了这些因素在检测HCC中的总体准确性。我们使用接收器操作员特征分析计算了亚组中灵敏度和特异性最高的AFP水平。
结果：肝硬化最常见的病因是丙型肝炎病毒（HCV）感染（60％）和酒精诱导（22％）。近11％的患者是人类免疫缺陷病毒（HIV）阳性。AFP水平大于20ng/mL检测HCC，敏感性为70.1％，特异性为89.8％。该AFP水平确定HCC患者的c统计量为0.87（95％置信区间，0.85-0.89）；HCV阴性患者的准确性明显高于HCV阳性患者（c统计量，0.89vs0.83；P=.007）。59ng/mL或更高的AFP水平在HCV相关肝硬化患者中最准确地检测到HCC;11ng/mL或更高的AFP水平在HCV阴性患者中准确地识别出HCC。AFP水平以0.62的c统计量识别早期HCC(95%置信区间，0.58-0.66),并且对HIV阳性患者的准确性水平明显高于HIV阴性患者（c统计量，0.81vs0.59；P<.001）。
结论：基于对肝硬化患者数据的回顾性分析，有或没有HCC，AFP水平最准确地检测没有HCV感染的患者的HCC。它在肝硬化和HIV感染患者中以高水平的准确性检测HCC。
