Diagnostic Evaluation of Des-Gamma-Carboxy Prothrombin versus α-Fetoprotein for Hepatitis B Virus-Related Hepatocellular Carcinoma in China: A Large-Scale, Multicentre Study.
Diagnostic Evaluation of Des-Gamma-Carboxy Prothrombin versus α-Fetoprotein for Hepatitis B Virus-Related Hepatocellular Carcinoma in China: A Large-Scale, Multicentre Study.
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DOI：
10.1371/journal.pone.0153227
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Gao C
中科院分区：
文献类型：
--
作者：
Ji J;Wang H;Li Y;Zheng L;Yin Y;Zou Z;Zhou F;Zhou W;Shen F;Gao C
肝细胞癌（HCC）的有效血清标志物目前缺乏，需要深入探索。我们的目的是在中国的一项大型多中心研究中评价脱-γ-羧基凝血酶原（DCP）用于识别B型肝炎病毒相关HCC的性能。2011年1月至2014年2月，从中国4家学术医学中心共入组了3个队列（A、B和C）中的1034例受试者，包括HCC和各种非HCC对照。对DCP和AFP进行盲平行检测。以受试者工作特征曲线下面积（AUC）评价诊断效能。在队列A中，包括521名受试者，包括患有HCC、肝转移、肝硬化（LC）和肝血管瘤的患者以及健康对照（HC），DCP区分HCC与各种对照的准确性比AFP高6.2-9.7%。队列B包括447例受试者，包括HCC、LC和慢性B型肝炎以及HC患者，DCP的准确性进一步提高（比AFP高12.3-20.67%）。DCP在早期HCC [AUC 0.837（95% CI：0.771-0.903）vs. 0.650（0.555-0.745）]和AFP阴性HCC [AUC：0.856（0.798-0.914）]的监测以及区分HCC和LC（准确度：92.9% vs.64.71%）方面的优势更为显著。较高的DCP水平与较差的临床行为和较短的无病生存期相关。DCP不仅在识别AFP阴性HCC和排除AFP阳性非HCC（肝硬化）方面与AFP互补，而且在HBV相关人群中显示出HCC监测、早期诊断、治疗反应和复发监测方面的改进性能。
An efficient serum marker for hepatocellular carcinoma (HCC) is currently lacking and requires intensive exploration. We aimed to evaluate the performance of des-gamma-carboxy prothrombin (DCP) for identifying hepatitis B virus-related HCC in a large, multicentre study in China. A total of 1034 subjects in three cohorts (A, B, and C) including HCC and various non-HCC controls were enrolled from 4 academic medical centers in China from January 2011 to February 2014. Blind parallel detections were conducted for DCP and AFP. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic efficacies. In cohort A, which comprised 521 subjects, including patients with HCC, liver metastasis, liver cirrhosis (LC), and liver hemangiomas as well as healthy controls (HCs), the accuracy of DCP for distinguishing HCC from various controls was 6.2–9.7% higher than that of AFP. In cohort B, which comprised 447 subjects, including patients with HCC, LC, and chronic hepatitis B as well as HC, the accuracy of DCP was further elevated (12.3–20.67% higher than that of AFP). The superiority of DCP to AFP was more profound in the surveillance of early HCC [AUC 0.837 (95% CI: 0.771–0.903) vs. 0.650 (0.555–0.745)] and AFP-negative HCC [AUC: 0.856 (0.798–0.914)] and in discriminating HCC from LC (accuracy: 92.9% vs.64.71%). Higher DCP levels were associated with worse clinical behaviors and shorter disease-free survival. DCP not only is complementary to AFP in identifying AFP-negative HCC and in excluding AFP-positive non-HCC (liver cirrhosis), but also demonstrates improved performance in HCC surveillance, early diagnosis, treatment response and recurrence monitoring in the HBV-related population.