The GALAD scoring algorithm based on AFP, AFP-L3, and DCP significantly improves detection of BCLC early stage hepatocellular carcinoma
The GALAD scoring algorithm based on AFP, AFP-L3, and DCP significantly improves detection of BCLC early stage hepatocellular carcinoma
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DOI：
10.1055/s-0042-119529
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发表时间：
2016-12-01
影响因子：
1.3
通讯作者：
Dechene, A.
中科院分区：
文献类型：
--
作者：
Best, J.;Bilgi, H.;Dechene, A.
背景：肝细胞癌（HCC）是全世界肝硬化患者死亡的主要原因之一。尽管进行了筛查，但早期 HCC 的检出率仍然很低。因此，大多数 HCC 病例是在肿瘤晚期发现的，治疗选择有限。为了促进早期诊断，本研究旨在验证 AFP、新型生物标记物 AFP-L3、DCP 以及称为 GALAD 的相关新型诊断算法组合的额外益处。 材料和方法：2007 年至 2008 年以及 2010 年至 2012 年期间，纳入了 285 名新诊断为 HCC 的患者和 402 名患有慢性肝病的对照患者。使用 mu TAS-Wako i30 自动免疫分析仪测量 AFP、AFP-L3 和 DCP。生物标志物的诊断性能作为单一参数并在逻辑回归模型中进行测量。此外，还验证了基于性别、年龄和上述生物标志物的诊断算法 (GALAD)。 结果：AFP、AFP-L3 和 DCP 对 HCC 检测显示出相当的敏感性和特异性。所有生物标志物的组合具有最高的敏感性，但特异性降低。相比之下，利用基于生物标志物的 GALAD 评分获得了 93.3% 的优异特异性和 85.6% 的敏感性。在 BCLC 0/A 期 HCC 场景中，GALAD 算法提供了最高的总体 AUROC，为 0.9242，优于任何其他标记物组合。 结论：我们可以在我们的队列中证明，联合使用各个生物标记物，特别是 GALAD，即使在 AFP 阴性肿瘤中，也能更好地检测早期 HCC。
Background: Hepatocellular carcinoma (HCC) is one of the leading causes of death in cirrhotic patients worldwide. The detection rate for early stage HCC remains low despite screening programs. Thus, the majority of HCC cases are detected at advanced tumor stages with limited treatment options. To facilitate earlier diagnosis, this study aims to validate the added benefit of the combination of AFP, the novel biomarkers AFP-L3, DCP, and an associated novel diagnostic algorithm called GALAD.Material and methods: Between 2007 and 2008 and from 2010 to 2012, 285 patients newly diagnosed with HCC and 402 control patients suffering from chronic liver disease were enrolled. AFP, AFP-L3, and DCP were measured using the mu TAS-Wako i30 automated immunoanalyzer. The diagnostic performance of biomarkers was measured as single parameters and in a logistic regression model. Furthermore, a diagnostic algorithm (GALAD) based on gender, age, and the biomarkers mentioned above was validated.Results: AFP, AFP-L3, and DCP showed comparable sensitivities and specifities for HCC detection. The combination of all biomarkers had the highest sensitivity with decreased specificity. In contrast, utilization of the biomarker-based GALAD score resulted in a superior specificity of 93.3 % and sensitivity of 85.6 %. In the scenario of BCLC 0/A stage HCC, the GALAD algorithm provided the highest overall AUROC with 0.9242, which was superior to any other marker combination.Conclusions: We could demonstrate in our cohort the superior detection of early stage HCC with the combined use of the respective biomarkers and in particular GALAD even in AFP-negative tumors.