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Feasibility of α-fetoprotein as a diagnostic tool for hepatocellular carcinoma in Korea
Dae Geon Ahn1, Hyung Joon Kim1, Hyun Kang2
1Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Insights
This study evaluated alpha-fetoprotein (AFP) for diagnosing hepatocellular carcinoma (HCC) in Korean patients. A cut-off of 100 ng/mL showed a good balance of sensitivity and specificity for HCC diagnosis.
Area of Science:
- Hepatology
- Oncology
- Diagnostic Biomarkers
Background:
- Hepatocellular carcinoma (HCC) is a significant health concern.
- Early diagnosis of HCC is crucial for effective treatment.
- Alpha-fetoprotein (AFP) is a commonly used but debated biomarker for HCC.
Purpose of the Study:
- To assess the diagnostic feasibility of serum AFP levels for HCC in a Korean patient cohort.
- To determine optimal AFP cut-off values for HCC detection.
Main Methods:
- Retrospective review of medical records from 732 Korean patients (HCC and cirrhosis).
- Matched case-control study design.
- Receiver operating characteristic (ROC) curve analysis to evaluate AFP performance.
Main Results:
- Mean AFP levels were significantly higher in HCC patients (3,315.6 ng/mL) than in cirrhosis patients (117.2 ng/mL).
- At a cut-off of 100 ng/mL, AFP demonstrated 37.70% sensitivity and 95.90% specificity.
- An AFP cut-off of 100 ng/mL offered better sensitivity than 200 ng/mL with comparable specificity.
Conclusions:
- AFP plays a role in diagnosing HCC in Korean patients.
- An AFP cut-off value of 100 ng/mL is suggested as appropriate for HCC diagnosis over 200 ng/mL.
- The optimal cut-off for early-stage HCC was identified as 17.4 ng/mL.
Background/Aims:
The aim of this study was to evaluate the feasibility of α-fetoprotein (AFP) as a diagnostic tool for hepatocellular carcinoma (HCC) in Korean patients.
Methods:
We retrospectively reviewed the medical records of HCC and cirrhosis patients at three hospitals. For each HCC patient, a cirrhosis patient matched for age, sex, etiology, and Child-Pugh classification was selected by simple random sampling. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis.
Results:
A total of 732 patients with HCC or cirrhosis were selected for each case and the control groups. The mean age was 54 years, and 72.4% of patients were male. The mean serum AFP levels in the HCC group and cirrhosis group were 3,315.6 and 117.2 ng/mL, respectively (p < 0.001). The area under the receiver operating characteristic curve for all HCC patients was 0.757. The sensitivity, specificity, and positive predictive value of AFP was 50.55%, 87.70%, and 80.43%, respectively, at a cut-off of 20 ng/mL; 37.70%, 95.90%, and 90.20%, respectively, at a cut-off of 100 ng/mL, and 30.05%, 97.27%, and 91.67%, respectively, at a cut-off of 200 ng/mL. A cut-off of 100 ng/mL was more sensitive than one of 200 ng/mL with equivalent specificity and positive predictive value.
Conclusions:
The cut-off AFP value for early-stage HCC was 17.4 ng/mL. Our study cautiously suggests that AFP has a role in the diagnosis of HCC, and that the appropriate value of AFP for the diagnosis of HCC may be 100 ng/mL rather than 200 ng/mL.
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