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Combined use of AFP, PIVKA-II, and AFP-L3 as tumor markers enhances diagnostic accuracy for hepatocellular carcinoma 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 
Citation
 SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, Vol.51(3) : 344-353, 2016 
Journal Title
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY
ISSN
 0036-5521 
Issue Date
2016
MeSH
Aged ; Area Under Curve ; Biomarkers/blood ; Biomarkers, Tumor/blood* ; Biomarkers, Tumor/immunology ; Carcinoma, Hepatocellular/blood* ; Carcinoma, Hepatocellular/diagnosis* ; Carcinoma, Hepatocellular/virology ; Female ; Hepatitis B, Chronic/complications ; Hepatitis C, Chronic/complications ; Humans ; Liver Cirrhosis/virology ; Liver Neoplasms/blood* ; Liver Neoplasms/diagnosis* ; Liver Neoplasms/virology ; Male ; Middle Aged ; Plant Lectins/immunology ; Protein Isoforms/blood ; Protein Precursors/blood ; Prothrombin ; ROC Curve ; Retrospective Studies ; alpha-Fetoproteins/immunology ; alpha-Fetoproteins/metabolism
Keywords
AFP ; AFP-L3 ; PIVKA-II ; biomarker ; hepatocellular carcinoma
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.
Files in This Item:
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DOI
10.3109/00365521.2015.1082190
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Kim, Hyon Suk(김현숙) ORCID logo https://orcid.org/0000-0001-5662-7740
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Shin, Seung Hwan(신승환)
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lim, Tae Seop(임태섭) ORCID logo https://orcid.org/0000-0002-4578-8685
Jung, Kyu Sik(정규식)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/147224
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