Serum α-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease:: influence of HBsAg and anti-HCV status
Serum α-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease:: influence of HBsAg and anti-HCV status
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DOI：
10.1016/s0168-8278(00)00053-2
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发表时间：
2001-04-01
影响因子：
25.7
通讯作者：
Bernardi, M
中科院分区：
文献类型：
--
作者：
Trevisani, F;D'Intino, PE;Bernardi, M
背景资料：在慢性肝病（CLD）患者中，病毒学状态是否影响甲胎蛋白（AFP）作为肝细胞癌（HCC）标志物的有效性尚不明确。方法：我们在病例对照研究中纳入了170例HCC和170例CLD患者，年龄、性别、CLD和HBsAg/抗-HCV状态相匹配。计算AFP敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。PPV和NPV用于评估另外三种HCC患病率（5%、10%和20%）。结果：最佳区分AFP值为16 ng/ml。20 ng/ml的值（建议进行HCC检查）具有相同的灵敏度（60.0 vs. 62.4%）和特异性（90.6 vs. 89.4%）。PPV 20 ng/ml为84.6%，但在肿瘤患病率为5%时降至25.1%。NPV为69.4%，在5%患病率时上升至97.7%。在不同的感染患者组中，PPV范围为80.0 - 90.9%，在5%的患病率下降至17.4-34.5%。在非感染患者中，任何HCC患病率的PPV均为100%。NPV范围为59.0 - 73.0%，在5%的患病率达到96.5-98.1%。结论：在CLD患者中，AFP监测遗漏了许多HCC，并在许多患者中不适当地引起恶性肿瘤的怀疑。它的有用性几乎不受CLD感染的影响。在未感染的患者中，AFP升高可能更能指示HCC。(C)2001年欧洲肝脏研究协会。由Elsevier Science B. V.出版，版权所有。
Background: It is not established whether virological status affects the efficency of alpha -fetoprotein (AFP) as a hepatocellular carcinoma (HCC) marker among patients with chronic liver disease (CLD).Methods: We enrolled in a case-control study 170 HCC and 170 CLD patients, matched for age, sex, CLD and HBsAg/anti-HCV status. The AFP sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. PPV and NPV were evaluated for three additional HCC prevalences (5, 10, and 20%).Results: The best discriminating AFP value was 16 ng/ml. A value of 20 ng/ml (above which investigations for HCC are recommended) had equivalent sensitivity (60.0 vs. 62.4%) and specificity (90.6 vs. 89.4%). PPV of 20 ng/ml was 84.6% but decreased to 25.1% at 5% tumor prevalence. NPV was 69.4% and rose to 97.7% at 5% prevalence. In the different groups of infected patients PPV ranged from 80.0 to 90.9%, falling to 17.4-34.5% at 5% prevalence. In non-infected patients PPV was 100% at any HCC prevalence. NPV ranged from 59.0 to 73.0%, reaching 96.5-98.1% at 5% prevalence.Conclusions: In CLD patients, AFP monitoring misses many HCCs and inappropriately arouses suspicion of malignancy in many patients. Its usefulness is barely affected by the infection responsible for CLD. An AFP elevation could be more indicative of HCC in non-infected patients. (C) 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.