Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2019; 25(36): 5515-5529
Published online Sep 28, 2019. doi: 10.3748/wjg.v25.i36.5515
Diagnostic value of gamma-glutamyltransferase/aspartate aminotransferase ratio, protein induced by vitamin K absence or antagonist II, and alpha-fetoprotein in hepatitis B virus-related hepatocellular carcinoma
Qiang Wang, Qi Chen, Xia Zhang, Xiao-Lan Lu, Qin Du, Tao Zhu, Guo-Yuan Zhang, Dong-Sheng Wang, Qu-Ming Fan
Qiang Wang, Xiao-Lan Lu, Qin Du, Guo-Yuan Zhang, Dong-Sheng Wang, Qu-Ming Fan, Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Qiang Wang, Faculty of Laboratory Medicine, Center for Translational Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Qi Chen, Department of Laboratory Medicine, Affiliated Sichuan Ba-Yi Rehabilitation Center of Chengdu University of TCM, Chengdu 610000, Sichuan Province, China
Xia Zhang, Department of Laboratory Medicine of the Ninth People’s Hospital of Chongqing, Chongqing 400700, China
Tao Zhu, Department of Preventive Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Author contributions: All authors contributed to the conceptualisation and design of the study; Wang Q, Chen Q, and Zhang X contributed to the clinical data collection and analysis, and prepared and wrote the first draft of this manuscript; Lu XL, Du Q, and Zhang GY contributed to the clinical data collection; Zhu T contributed to the statistical analysis; Wang DS and Fan QM designed this study and revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of North Sichuan Medical College.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agree to treatment by written consent.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qu-Ming Fan, PhD, Research Assistant Professor, Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong 637000, Sichuan Province, China. fanqum@163.com
Telephone: +86-817-2190089 Fax: +86-817-2222856
Received: July 25, 2019
Peer-review started: July 25, 2019
First decision: August 17, 2019
Revised: August 25, 2019
Accepted: September 9, 2019
Article in press: September 9, 2019
Published online: September 28, 2019
Processing time: 64 Days and 21.2 Hours
ARTICLE HIGHLIGHTS
Research background

Protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP) are widely used biomarkers in the diagnosis of hepatocellular carcinoma (HCC), and have been written into the guidelines for HCC diagnosis published by the National Society of Hepatology of different countries. However, PIVKA-II and AFP have unsatisfactory specificity and sensitivity in the diagnosis of hepatitis B virus (HBV)-related HCC, especially in early-stage HBV-related HCC.

Research motivation

Researchers have evaluated the diagnostic value of biomarkers in HCC. However, it is difficult to obtain ideal biomarkers for early-stage HCC, even if combined detection of existing biomarkers. This study evaluated the diagnostic value of the ratio of gamma-glutamyltransferase to aspartate aminotransferase (γ-GT/AST ratio) in different classifications of HBV-related HCC, which can effectively improve the diagnostic efficiency for HBV-related HCC.

Research objectives

The objective of this study was to evaluate the diagnostic value of the γ-GT/AST ratio, PIVKA-II, and AFP, alone or in combination, in different categories of HBV-related HCC.

Research methods

We retrospectively analyzed the clinical and laboratory data of HBV-related HCC and chronic hepatitis B (CHB) patients, and classified those data according to the tumour size and serum level of HBV DNA. The diagnostic value of the γ-GT/AST ratio, PIVKA-II, and AFP in different categories of HBV-related HCC was evaluated comprehensively and systematically.

Research results

Tumour size was positively correlated with serum levels of PIVKA-II and AFP in HCC patients, but there was no correlation between tumour size and the γ-GT/AST ratio. The areas under receiver-operating characteristic curves (AUROCs) of the γ-GT/AST ratio were not significantly different between early-stage HBV-related HCC patients and HBV-related HCC patients. When PIVKA-II and AFP were combined with the γ-GT/AST ratio in the diagnosis of HBV-related HCC patients, early-stage HBV-related HCC patients, HBV DNA+ HCC patients, and HBV DNA- HCC patients, the AUROCs of those biomarkers were increased.

Research conclusions

The γ-GT/AST ratio is a useful biomarker for the diagnosis of HBV-related HCC and may be more useful than PIVKA-II and AFP in the diagnosis of early-stage HBV-related HCC. The combination of PIVKA-II and AFP with the γ-GT/AST ratio can enhance the diagnostic value of these biomarkers in different categories of HBV-related HCC.

Research perspectives

This study assessed the diagnostic value of the γ-GT/AST ratio, PIVKA-II, and AFP in different categories of HBV-related HCC. According to the correlation between tumour size of HBV-related HCC patients and the γ-GT/AST ratio, we inferred that the γ-GT/AST ratio may be more useful than PIVKA-II and AFP in the diagnosis of early-stage HCC. This hypothesis should be validated in future studies.