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HCC-ART score, a simple, highly sensitive and specific test for early diagnosis of hepatocellular carcinoma: a
A M Attallah1, M M Omran, A A Attallah
1R & D Department, Biotechnology Research Center, PO Box (14), 23 July Street, Industrial Zone, New Damietta 34517, Egypt.
Insights
A new scoring system, Hepatocellular carcinoma-AFP-routine test (HCC-ART), accurately distinguishes liver cancer from chronic liver disease using simple lab tests. This tool enhances HCC screening and surveillance globally.
Area of Science:
- Hepatology
- Oncology
- Diagnostic Accuracy
Background:
- A need exists for a simple scoring system to differentiate Hepatocellular Carcinoma (HCC) from chronic liver diseases (CLD).
- The ideal scoring system should rely solely on routine laboratory tests, avoiding complex or specialized procedures.
Purpose of the Study:
- To develop and validate a simple scoring system for discriminating HCC from CLD.
- To assess the diagnostic accuracy of the proposed scoring system using routine laboratory markers.
Main Methods:
- Retrospective analysis of data from an estimation group (1351 patients) and a validation group (2208 patients).
- Comparison of liver fibrosis-negative controls and liver cirrhosis against HCC.
- Development of the Hepatocellular carcinoma-AFP-routine test (HCC-ART) using Area Under the ROC Curve (AUC).
Main Results:
- HCC-ART demonstrated high diagnostic accuracy for liver cirrhosis versus HCC (AUC 0.99, sensitivity 97%, specificity 96% in estimation; AUC 0.95, sensitivity 90%, specificity 83% in validation).
- HCC-ART achieved excellent discrimination between HCC and liver fibrosis (sensitivity 97%, specificity 100%).
- HCC-ART showed superior performance compared to AFP alone in various HCC subgroups.
Conclusions:
- The Hepatocellular carcinoma-AFP-routine test (HCC-ART) significantly improves the accuracy of HCC screening and surveillance.
- HCC-ART is a practical tool that can be implemented worldwide without requiring additional resources or complex tests.
Background:
A simple scoring system is needed to discriminate HCC from patients with chronic liver diseases (CLD). The simplest score would be one that requires only variables that can be documented simply from routine laboratory tests without the need for sophisticated tests.
Methods:
Data from the estimation group (1351 patients) and the validation group (2208 patients) were retrospectively analysed. Liver fibrosis-negative control and liver cirrhosis were compared with HCC. Area under ROC curve (AUC) were used to develop HCC-α-fetoprotein-routine test (HCC-ART).
Results:
Hepatocellular carcinoma-AFP-routine test showed diagnostic accuracy for liver cirrhosis vs HCC with ROC curves of 0.99%, sensitivity of 97%, and specificity of 96% in the estimation, and 0.95%, 90%, and 83%, respectively, in the validation. Sensitivity (97%) and specificity (100%) were obtained to discriminate HCC from liver fibrosis. Area under curve for AFP at 400 U l(-1) was 0.70, sensitivity was 41%, and specificity was 99% in the estimation, and 0.77%, 54%, and 99%, respectively, in the validation. The AUC for HCC-ART in HCC with single tumour, absent vascular invasion, size <2 cm and CLIP score (0-1) were 0.95, 0.93, 0.86, 0.87, respectively, compared with 0.72, 0.71, 0.71, 0.50, respectively, for AFP.
Conclusion:
Hepatocellular carcinoma-AFP-routine test could increase the accuracy of HCC screening and surveillances and could be used worldwide without extra efforts.
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