BACKGROUND & AIMS: Current screening algorithms for hepatocellular carcinoma (HCC) view each testing interval independently, without considering prior test results. We investigated whether measurements of α-fetoprotein (AFP), over time, can be used to identify patients most likely to develop HCC. METHODS: We performed a nested case-control study using data from subjects in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis trial; 82 patients with HCC were matched 1:3 to individuals without HCC (controls), using bootstrap methods to ensure similar follow-up times between groups. We assessed the independent association between development of HCC and the following: (1) most recent level of AFP, (2) standard deviation in level of AFP, and (3) rate of increase in AFP using a multiple logistic regression that included patient-specific risk factors such as age, platelet count, and smoking status. RESULTS: In bivariable analysis, all 3 AFP metrics were associated with HCC development; the most strongly associated was the standard deviation of AFP (odds ratio, 1.03 per unit increase in standard deviation; P < .001). Incorporating the standard deviation of AFP and rate of AFP increase, along with patient-specific risk factors, improved the prognostic accuracy to an area under the receiver-operating characteristic curve of 0.81, compared with 0.76 when only the most recent AFP level was used. CONCLUSIONS: Patterns of AFP test results can more accurately identify patients with hepatitis C and advanced fibrosis or cirrhosis most likely to develop HCC, compared with most recent AFP test results.
BACKGROUND & AIMS: Current screening algorithms for hepatocellular carcinoma (HCC) view each testing interval independently, without considering prior test results. We investigated whether measurements of α-fetoprotein (AFP), over time, can be used to identify patients most likely to develop HCC. METHODS: We performed a nested case-control study using data from subjects in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis trial; 82 patients with HCC were matched 1:3 to individuals without HCC (controls), using bootstrap methods to ensure similar follow-up times between groups. We assessed the independent association between development of HCC and the following: (1) most recent level of AFP, (2) standard deviation in level of AFP, and (3) rate of increase in AFP using a multiple logistic regression that included patient-specific risk factors such as age, platelet count, and smoking status. RESULTS: In bivariable analysis, all 3 AFP metrics were associated with HCC development; the most strongly associated was the standard deviation of AFP (odds ratio, 1.03 per unit increase in standard deviation; P < .001). Incorporating the standard deviation of AFP and rate of AFP increase, along with patient-specific risk factors, improved the prognostic accuracy to an area under the receiver-operating characteristic curve of 0.81, compared with 0.76 when only the most recent AFP level was used. CONCLUSIONS: Patterns of AFP test results can more accurately identify patients with hepatitis C and advanced fibrosis or cirrhosis most likely to develop HCC, compared with most recent AFP test results.
Authors: Kristina Tzartzeva; Joseph Obi; Nicole E Rich; Neehar D Parikh; Jorge A Marrero; Adam Yopp; Akbar K Waljee; Amit G Singal Journal: Gastroenterology Date: 2018-02-06 Impact factor: 22.682
Authors: Purva Gopal; Adam C Yopp; Akbar K Waljee; Jason Chiang; Mahendra Nehra; Pragathi Kandunoori; Amit G Singal Journal: Clin Gastroenterol Hepatol Date: 2013-10-02 Impact factor: 11.382
Authors: Eman A Toraih; Manal S Fawzy; Abdullah I El-Falouji; Elham O Hamed; Nader A Nemr; Mohammad H Hussein; Noha M Abd El Fadeal Journal: Mol Med Date: 2016-09-12 Impact factor: 6.354
Authors: Hashem B El-Serag; Fasiha Kanwal; Jessica A Davila; Jennifer Kramer; Peter Richardson Journal: Gastroenterology Date: 2014-01-23 Impact factor: 22.682