Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9264
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
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.
Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.
This study aimed to evaluate the role of high-risk factors in diagnosing stratified PLC cases, especially the diagnostic value of AFP.
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.
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).
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.
PLC was the second leading cause of cancer-related mortality in 2014. PLC incidence rates vary across clinical etiologies and conditions.