Evaluation of high-risk factors and the diagnostic value of alpha-fetoprotein in the stratification of primary liver cancer

doi:10.12998/wjcc.v10.i26.9264

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World Journal of Clinical Cases

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World J Clin Cases. Sep 16, 2022; 10(26): 9264-9275
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9264

Table 1 Influence of high-risk factors on primary liver cancer stratified by Child-Pugh score

Factors	Criterion: Child-Pugh score			Statistics	P value
Factors	A	B	C	Statistics	P value
Male (%)	40 (76.9)	61 (77.2)	16 (76.9)	0.06	0.814
Age (yr)	59.40 ± 10.18	62.83 ± 9.85	58.50 ± 7.20	2.78	0.065
History of smoking (%)	16 (30.2)	22 (27.8)^a	12 (60.0)	7.74	0.021
History of drinking (%)	13 (24.5)^a	26 (32.9)	11 (55.0)	6.11	0.047
HBsAg (+) (%)	38 (71.7)	56 (70.9)	14 (70.0)	0.02	0.989
HCV-Ag (+) (%)	3 (5.7)	5 (6.3)	0 (0.0)	1.31	0.520
Non-alcoholic fatty liver (%)	9 (17.0)	18 (22.8)	1 (5.0)	3.47	0.176

^aCompared with “C”, P < 0.0167. HBsAg: Hepatitis B virus antigen; HCV: Hepatitis C virus.

Table 2 Influence of high-risk factors on primary liver cancer stratified by clinical stage of cirrhosis

Factors	Criterion: Clinical stage of cirrhosis			Statistics	P value
Factors	No cirrhosis	Compensated	Decompensated	Statistics	P value
Male (%)	99 (72.3)	33 (78.6)	84 (77.1)	1.08	0.582
Age (yr)	62.93 ± 11.85	61.21 ± 1.58	60.93 ± 9.04	1.14	0.322
History of smoking (%)	47 (34.3)	13 (30.2)	37 (33.9)	0.26	0.880
History of drinking (%)	50 (36.5)	11 (26.2)	39 (35.8)	1.59	0.451
HBsAg (+) (%)	46 (33.6)	32 (76.2) ^a	76 (69.1) ^a	41.27	< 0.001
HCV-Ag (+) (%)	9 (6.6)	2 (4.8)	6 (5.5)	0.25	0.883
Non-alcoholic fatty liver (%)	39 (28.5)	9 (21.4)	19 (17.3)	4.38	0.112

^aCompared with “No cirrhosis”, P < 0.0167. HBsAg: Hepatitis B virus antigen; HCV: Hepatitis C virus.

Table 3 Influence of high-risk factors on primary liver cancer stratified by pathological classification of tumor size

Factors	Criterion: Pathological classification of tumor size					Statistics	P value
Factors	Small	Medium	Large	Massive	Diffuse	Statistics	P value
Male (%)	30 (68.2)	17 (70.8)	30 (66.7)	22 (75.9)	117 (80.1)	5.05	0.283
Age (yr)	62.86 ± 9.03	59.45 ± 10.43	61.86 ± 8.86	57.79 ± 11.69	63.03 ± 11.75	1.75	0.139
History of smoking (%)	9 (20.5)	9 (37.5)	12 (26.7)	12 (41.4)	55 (37.4)	6.29	0.179
History of drinking (%)	10 (22.7)	8 (33.3)	14 (31.1)	11 (37.9)	57 (38.8)	4.28	0.370
HBsAg (+) (%)	20 (45.5)	14 (58.3)	23 (51.1)	14 (48.3)	83 (56.5)	2.30	0.680
HCV-Ag (+) (%)	3 (6.8)	1 (4.2)	4 (8.9)	2 (6.9)	7 (4.8)	1.32	0.858
Cirrhosis (%)	31 (70.5)	17 (70.0)	20 (44.4)	10 (34.5)^a	74 (50.3)	14.15	0.007
Non-alcoholic fatty liver (%)	10 (22.7)	7 (29.2)	7 (15.6)	7 (24.1)	36 (24.5)	2.11	0.715

^aCompared with “Small”, P < 0.005. HBsAg: Hepatitis B virus antigen; HCV: Hepatitis C virus.

Table 4 Influence of high-risk factors on primary liver cancer stratified by Barcelona stage

Factors	Criterion: Barcelona stage				Statistics	P value
Factors	A stage	B stage	C stage	D stage	Statistics	P value
Male (%)	36 (67.9)	42 (76.4)	51 (75.0)	87 (77.7)	1.90	0.594
Age (yr)	60.25 ± 11.57	65.15 ± 12.40	62.50 ± 11.28	60.80 ± 9.05	2.53	0.057
History of smoking (%)	14 (26.4)	20 (36.4)	23 (33.8)	40 (35.4)	1.58	0.664
History of drinking (%)	15 (28.3)	16 (29.1)	28 (41.2)	41 (36.3)	3.11	0.375
HBsAg (+) (%)	21 (39.6)^a	24 (43.6^a	31 (45.6)^a	78 (69.0)	18.90	< 0.001
HCV-Ag (+) (%)	4 (7.5)	4 (7.3)	3 (4.4)	6 (5.3)	0.79	0.852
Cirrhosis (%)	11 (20.8)^a	13 (23.6)^a	15 (22.1)^a	113 (100.0)	167.33	< 0.001
Non-alcoholic fatty liver (%)	14 (26.4)	18 (32.7)	15 (22.1)	20 (17.7)	5.08	0.166

^aCompared with “D”, P < 0.0083. HBsAg: Hepatitis B virus antigen; HCV: Hepatitis C virus.

Table 5 Analysis of alpha-fetoprotein level and diagnosis positive rate in patients with primary liver cancer, chronic hepatitis and cirrhosis

Group	n	Men:Women	Age (mean ± S)	AFP (ng/mL)	Diagnosis positive rate, %
Chronic hepatitis B	217	157:60	59.85 ± 7.25	2.77 (1.67, 5.15)^a	1.4^b
Cirrhosis	279	204:75	60.99 ± 9.91	3.26 (1.74, 9.80)^a	4.7^b
PLC	289	216:73	61.92 ± 10.84	63.69 (3.28, 1210.00)	35.6
Statistics		0.536	2.869	121.974	147.565
P value		0.765	0.057	< 0.001	< 0.001

^aCompared with “PLC group”, P < 0.05.

^bCompared with “PLC group”, P < 0.0167. AFP: Alpha-fetoprotein; PLC: Primary liver cancer.

Table 6 Alpha-fetoprotein expression levels in primary liver cancer by different standards

Layering standard	Group	AFP (ng / mL)	F	P value
Cirrhosis clinical stage			10.03	0.007
	No cirrhosis	7.32 (2.28, 7.32)
	Compensated cirrhosis	267.40 (12.56, 1210.00)^a		0.004
	Decompensated cirrhosis	130.60 (6.69, 1210.00)^a		0.005
Child-Pugh classification			0.26	0.774
	A grade	461.16 ± 546.16
	B grade	516.74 ± 534.18
	C grade	549.64 ± 561.80
Classification of tumor size			21.70	< 0.001
	Small liver cancer	4.54 (1.78, 99.19)
	Medium liver cancer	12.56 (2.66, 521.65)
	Large liver cancer	17.58 (2.10, 782.25)
	Massive liver cancer	249.90 (4.14, 1210.00)
	Diffuse liver cancer	267.40 (3.69, 1210.00)^b		0.007
Barcelona stage			8.56	0.036
	Phase A	3.76 (1.78, 478.95)
	Phase B	103.90 (3.17, 1149.50)
	Phase C	111.90 (3.18, 1210.00)
	Phase D	116.25 (6.59, 1210.00)^c		0.009

^aCompared with “no cirrhosis”, P < 0.05.

^bCompared with “small liver cancer”, P < 0.05.

^cCompared with “Phase A”, P < 0.05. AFP: Alpha-fetoprotein.

Table 7 Analysis of diagnostic value of alpha-fetoprotein for primary liver cancer with different criteria

Layering standard	Group	AUC	Std.Error	P value	95%CI	Sensitivity, %	Specificity, %
Child-Pugh classification	A grade	0.759	0.0424	< 0.0001	(0.721, 0.794)	62.26	84.68
	B grade	0.847	0.0279	< 0.0001	(0.815, 0.875)	77.22	81.45
	C grade	0.821	0.0575	< 0.0001	(0.785, 0.853)	75.00	81.25
Cirrhosis clinical stage	No	0.647	0.0303	< 0.0001	(0.608, 0.684)	38.69	94.56
	Compensated cirrhosis	0.846	0.0369	< 0.0001	(0.813, 0.875)	78.57	81.05
	Decompensated cirrhosis	0.800	0.0276	< 0.0001	(0.766, 0.8310)	69.09	83.47
Classification of tumor size	Small	0.595	0.0514	0.0642	(0.552, 0.637)	38.64	84.68
	Medium	0.684	0.0636	0.0038	(0.642, 0.724)	66.67	73.39
	Large	0.675	0.0520	0.0008	(0.634, 0.714)	66.67	71.98
	Massive	0.805	0.0411	< 0.0001	(0.769, 0.838)	51.72	96.17
	Diffuse	0.785	0.0257	< 0.0001	(0.751, 0.816)	62.59	90.93
Barcelona stage	Phase A	0.592	0.0481	0.0547	(0.550, 0.634)	30.19	96.17
	Phase B	0.741	0.0415	< 0.0001	(0.703, 0.778)	52.73	90.93
	Phase C	0.731	0.0403	< 0.0001	(0.692, 0.767)	52.94	93.35
	Phase D	0.799	0.0271	< 0.0001	(0.765, 0.830)	68.14	83.47

AUC: Area under the curve.

Table 8 Evaluation of four indicators for diagnosing small liver cancer alone and in combination

Diagnostic indicators	AUC	Sensitivity, %	Specificity, %	Std.Error	95%CI	Z	P value
AFP	0.595	38.64	84.68	0.0519	(0.552, 0.632)	1.93	0.067
CEA	0.649	52.27	75.22	0.0461	(0.589, 0.706)	3.23	0.0013
CA-199	0.719	81.82	66.18	0.0467	(0.671, 0.763)	4.69	< 0.0001
GGT	0.728	77.27	56.89	0.0390	(0.671, 0.780)	5.84	< 0.0001
Combined diagnosis	0.810	68.18	79.56	0.0349	(0.758, 0.855)	8.90	< 0.0001

AUC: Area under the curve; AFP: Alpha-fetoprotein; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; GGT: Gamma-glutamyl transferase.

Table 9 Evaluation of the four indicators for the diagnosis of Barcelona Clinic Liver Cancer stage A liver cancer alone and in combination

Diagnostic indicators	AUC	Sensitivity, %	Specificity, %	Std.Error	95%CI	Z	P value
AFP	0.593	30.19	96.17	0.0481	(0.550, 0.634)	1.93	0.0538
CEA	0.611	32.08	96.00	0.0462	(0.551, 0.669)	1.197	0.2313
CA-199	0.608	75.47	42.86	0.0429	(0.548, 0.666)	2.511	0.0121
GGT	0.743	60.38	78.22	0.0380	(0.688, 0.794)	6.409	< 0.0001
Combined diagnosis	0.843	66.04	91.96	0.0319	(0.794, 0.883)	10.738	< 0.0001

AUC: Area under the curve; AFP: Alpha-fetoprotein; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; GGT: Gamma-glutamyl transferase.

Citation: Jiao HB, Wang W, Guo MN, Su YL, Pang DQ, Wang BL, Shi J, Wu JH. Evaluation of high-risk factors and the diagnostic value of alpha-fetoprotein in the stratification of primary liver cancer. World J Clin Cases 2022; 10(26): 9264-9275
URL: https://www.wjgnet.com/2307-8960/full/v10/i26/9264.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i26.9264