The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Serum Levels of Alpha Fetoprotein Increased More Than 10 Years Before Detection of Hepatocellular Carcinoma
10.1016/j.cgh.2020.04.084. Online ahead of print.
David M Hughes1, Sarah Berhane1, C A Emily de Groot2, Hidenori Toyoda3, Toshifumi Tada3, Takashi Kumada4, Shinji Satomura5, Naoshi Nishida6, Masatoshi Kudo6, Toru Kimura7, Yukio Osaki8, Ruwanthi Kolamunage-Dona1, Ruben Amoros Salvador9, Tom Bird10, Marta Garc?a-Fiñana1, Philip Johnson11
Author information
1Department of Biostatistics, University of Liverpool, UK.
2Department of Economics, University of St Andrews, UK.
3Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
4Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
5Department of Molecular Biochemistry and Clinical Investigation, Osaka University Graduate School of Medicine, Osaka, Japan.
6Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
7Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
8Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan; Department of Internal Medicine, Meiwa Hospital, Nishinomiya, Japan.
9School of Mathematics, University of Edinburgh, UK.
10MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, UK.
11Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK. Electronic address: Philip.Johnson@liverpool.ac.uk.
Abstract
Background & aims: Ultrasound (US)-based screening has been recommended for patients with an increased risk of hepatocellular Carcinoma (HCC). US analysis is, however, limited in patients who are obese or have small tumors. Addition of measurement of serum level of alpha-fetoprotein (AFP) to US analysis can increase detection of HCC. We analyzed data from patients with chronic liver disease, collected over 15 years in an HCC surveillance program, to develop a model to assess risk of HCC.
Methods: We collected data from 3450 patients with chronic liver disease undergoing US surveillance in Japan from March 1998 through April 2014 and followed for a median 8.83 years. We performed longitudinal discriminant analysis of serial AFP measurements (median number of observations/patient, 56; approximate every 3 months) to develop a model to determine risk of HCC. We validated the model using data from 2 cohorts of patients with chronic liver disease in Japan (404 and 2754 patients) and 1 cohort in Scotland (1596 patients).
Results: HCC was detected in 413 patients (median tumor diameter, 1.8 cm), during a median follow-up time of 6.60 years. In the development dataset, the model identified patients who developed HCC with an area under the curve of 0.78; it correctly identified 74.3% of patients who did develop HCC, and 72.9% of patients who did not. Overall, 73.1% of patients were correctly classified. The model could be used to assign patients to a high-risk group (27.5 HCCs/1000 patient-years) vs a low-risk group (4.9 HCCs/1000 patient-years). Similar performance was observed when the model was used to assess patients with cirrhosis. Analysis of the validation cohorts produced similar results.
Conclusions: We developed and validated a model to identify patients with chronic liver disease who are at risk for HCC based on change in serum level of AFP over time. The model could be used to assign patients to high-risk vs low-risk groups, and might be used to select patients for surveillance.