Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2022; 10(26): 9264-9275
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9264
Evaluation of high-risk factors and the diagnostic value of alpha-fetoprotein in the stratification of primary liver cancer
Hong-Bin Jiao, Wei Wang, Meng-Nan Guo, Ya-Li Su, De-Quan Pang, Bao-Lin Wang, Jun Shi, Jing-Hua Wu
Hong-Bin Jiao, Wei Wang, Meng-Nan Guo, Ya-Li Su, Bao-Lin Wang, Jing-Hua Wu, Clinical Laboratory, Tangshan Maternal and Child Health Care Hospital, North China University of Science and Technology, Tangshan 063000, Hebei Province, China
De-Quan Pang, Department of Oncology, Tangshan Maternal and Child Health Care Hospital, North China University of Science and Technology, Tangshan 063000, Hebei Province, China
Jun Shi, Clinical Laboratory, Tangshan Nanhu Hospital, Tangshan 063000, Hebei Province, China
Author contributions: Wu JH contributed to conception and design; Jiao HB contributed to collection and assembly of data; Jiao HB and Wang W contributed to manuscript writing, data analysis and interpretation; all authors contributed to final approval of the manuscript; Jiao HB and Wang W contributed equally to this work.
Supported by High-End Talent Funding Project in Hebei Province, No. A202003005; Hebei Provincial Health Commission Office, No. G2019074; Science and Technology Research Project of Hebei Higher Education Institutions (ZD2018090) and Natural Science Foundation of Hebei Province, No. H2019209355.
Institutional review board statement: The study was reviewed and approved by the [Ethics Committee of North China University of Science and Technology] Institutional Review Board [Approval No. 2018109].
Informed consent statement: Our study was retrospective and informed consent was waived.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: Dataset available from the corresponding author at tswujinghua@126.com.
Open-Access: This article 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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Hua Wu, Doctor, PhD, Chief Technician, Professor, Clinical Laboratory, Tangshan Maternal and Child Health Care Hospital, North China University of Science and Technology, No. 1 Hetai Road, Lunan District, Tangshan 063000, Hebei Province, China. tswujinghua@163.com
Received: November 10, 2021
Peer-review started: November 10, 2021
First decision: December 2, 2021
Revised: December 10, 2022
Accepted: August 5, 2022
Article in press: August 5, 2022
Published online: September 16, 2022
Abstract
BACKGROUND

Alpha-fetoprotein (AFP) is one of the diagnostic standards for primary liver cancer (PLC); however, AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.

AIM

To evaluate the effects of high-risk factors and the diagnostic value of AFP in stratified PLC.

METHODS

In total, 289 PLC cases from 2013 to 2019 were selected for analysis. First, the contributions of high-risk factors in stratifying PLC were compared according to the following criteria: Child–Pugh score, clinical stage of liver cirrhosis, tumor size, and Barcelona Clinic Liver Cancer (BCLC) stage. Then, the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves. For PLC cases in which AFP played little role, the diagnostic values of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), gamma-glutamyl transferase (GGT), and AFP were analyzed.

RESULTS

The roles of high-risk factors differed in stratified PLC. The incidence of smoking and drinking history was higher in PLC with Child–Pugh scores of C (P < 0.0167). The hepatitis B virus (HBV) infection rate in PLC with cirrhosis was more than in PLC without cirrhosis (P < 0.0167). Small tumors were more prone to cirrhosis than large tumors (P < 0.005). BCLC stage D PLC was more likely to be associated with HBV infection and cirrhosis (P < 0.0083). AFP levels were higher in PLC with cirrhosis, diffuse tumors, and BCLC stage D disease. In diagnosing PLC defined as Child–Pugh A, B, and C, massive hepatoma, diffuse hepatoma, BCLC stage B, C, and D, and AFP showed significant diagnostic value [all area under the curve (AUC) > 0.700]. However, these measures were meaningless (AUC < 0.600) in small hepatomas and BCLC A stage PLC, but could be replaced by the combined detection of CEA, CA 19-9, GGT, and AFP (AUC = 0.810 and 0.846, respectively).

CONCLUSION

Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.

Keywords: Primary liver cancer, Stratification, Risk factors, Alpha-fetoprotein, Receiver operating characteristic curve, Diagnostics

Core Tip: To evaluate the effects of high-risk factors and the diagnostic value of alpha-fetoprotein (AFP) in stratified primary liver cancer (PLC), 289 cases were selected for analysis. First, the contributions of high-risk factors in stratifying PLC were compared. Then, the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves. For PLC cases in which AFP played little role, the diagnostic values of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9, gamma-glutamyl transferase, and AFP were analyzed. It was concluded that stratification of PLC was essential for precise diagnoses and it benefited from diagnostic values of AFP.