The Index sAGP is Valuable for Distinguishing Atypical Hepatocellular Carcinoma from Atypical Benign Focal Hepatic
Qing-Qing Luo1, Qiao-Nan Li1, Dan Cai1
1Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Jiangxi Institute of Gastroenterology & Hepatology, Nanchang, People's Republic of China.
Insights
A new blood test index, sAGP, effectively differentiates atypical hepatocellular carcinoma (aHCC) from atypical benign focal hepatic lesions (aBFHL) without invasive procedures. This offers a practical, non-invasive diagnostic tool for liver lesions.
Area of Science:
- Hepatology
- Oncology
- Biochemistry
Background:
- Distinguishing atypical hepatocellular carcinoma (aHCC) from atypical benign focal hepatic lesions (aBFHL) often requires invasive pathological examination.
- Developing non-invasive diagnostic methods is crucial for improving patient management and reducing healthcare burdens.
Purpose of the Study:
- To develop and validate non-invasive approaches using conventional blood indicators for the differential diagnosis of aHCC and aBFHL.
- To identify novel blood-based biomarkers that can accurately differentiate between malignant and benign liver lesions.
Main Methods:
- Retrospective analysis of clinical data from hospitalized patients with pathologically confirmed focal hepatic lesions.
- Development and evaluation of derived blood indexes using mathematical operations on conventional indicators like alpha-fetoprotein (AFP), gamma-glutamyltransferase (GGT), and platelet (PLT) counts.
- Utilizing receiver operating characteristic (ROC) curve analysis to assess the diagnostic performance of the indexes.
Main Results:
- The GPR index (GGT/PLT ratio) showed moderate performance (AUROC = 0.853).
- A newly developed index, sAGP [(standardized AFP + standardized GGT)/standardized PLT], demonstrated superior diagnostic accuracy with AUROCs ranging from 0.862 to 0.925 across different patient subgroups.
- The sAGP index proved effective in differentiating overall aHCC from aBFHL, as well as specific subgroups including BCLC stage 0/A, TNM stage I, small lesions, and AFP-negative cases.
Conclusions:
- The sAGP index is a highly efficient, simple, and practical metric for the non-invasive differentiation of aHCC from aBFHL.
- This novel blood-based index offers a promising alternative to invasive diagnostic procedures.
- The sAGP index has the potential to significantly improve the diagnostic workflow for patients with atypical focal hepatic lesions.
Purpose:
The differential diagnosis of atypical hepatocellular carcinoma (aHCC) and atypical benign focal hepatic lesions (aBFHL) usually depends on pathology. This study aimed to develop non-invasive approaches based on conventional blood indicators for the differential diagnosis of aHCC and aBFHL.
Patients And Methods:
Hospitalized patients with pathologically confirmed focal hepatic lesions and their clinical data were retrospectively collected, in which patients with HCC with serum alpha-fetoprotein (AFP) levels of ≤200 ng/mL and atypical imaging features were designated as the aHCC group (n = 224), and patients with benign focal hepatic lesions without typical imaging features were designated as the aBFHL group (n = 178). The performance of indexes (both previously reported and newly constructed) derived from conventional blood indicators by four mathematical operations in distinguishing aHCC and aBFHL was evaluated using the receiver operating characteristic (ROC) curve and diagnostic validity metrics.
Results:
Among ten previously reported derived indexes related to HCC, the index GPR, the ratio of γ-glutamyltransferase (GGT) to platelet (PLT), showed the best performance in distinguishing aHCC from aBFHL with the area under ROC curve (AUROC) of 0.853 (95% CI 0.814-0.892), but the other indexes were of little value (AUROCs from 0.531 to 0.700). A new derived index, sAGP [(standardized AFP + standardized GGT)/standardized PLT], was developed and exhibited AUROCs of 0.905, 0.894, 0.891, 0.925, and 0.862 in differentiating overall, BCLC stage 0/A, TNM stage I, small, and AFP-negative aHCC from aBFHL, respectively.
Conclusion:
The sAGP index is an efficient, simple, and practical metric for the non-invasive differentiation of aHCC from aBFHL.
