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
Processing time: 295 Days and 21 Hours
ARTICLE HIGHLIGHTS
Research background

Stratified diagnosis of primary liver cancer (PLC) was essential, and the high-risk factors had distinct roles in PLC classifications. Alpha-fetoprotein (AFP) level functioned as a diagnostic biomarker in the stratified PLC population that included the following: Poor function, advanced hepatoma, and massive and diffuse tumors. For small hepatomas and Barcelona Clinic Liver Cancer (BCLC) A stage PLC, combined detection of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), gamma-glutamyl transferase (GGT), and AFP is a more promising approach to diagnosing PLC compared with testing AFP alone.

Research motivation

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

Research objectives

This study aimed to evaluate the role of high-risk factors in diagnosing stratified PLC cases, especially the diagnostic value of AFP.

Research methods

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 CEA, CA 19-9, GGT, and AFP were analyzed.

Research results

The roles of high-risk factors differed in stratified PLC. AFP levels were higher in PLC with cirrhosis, diffuse tumors, and BCLC stage D disease. However, these measures were meaningless [area under the curve (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).

Research conclusions

PLC incidence rates vary across clinical etiologies and conditions such as liver disease severity; even within the same clinical entity, individual PLC risk is heterogeneous across patients for unknown reasons. Hence, clinically meaningful utility must be demonstrated under specific clinical scenarios for a diagnostic modality to be adopted into regular use.

Research perspectives

PLC was the second leading cause of cancer-related mortality in 2014. PLC incidence rates vary across clinical etiologies and conditions.