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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 11
Nov.  2023
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Diagnostic efficacy of alpha-fetoprotein and alpha-fetoprotein L3% in hepatitis B virus-related early-stage hepatocellular carcinoma

DOI: 10.3969/j.issn.1001-5256.2023.11.014
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  • Corresponding author: ZHU Jianyun, 13719366255@139.com (ORCID: 0000-0002-2875-7932)
  • Received Date: 2023-02-24
  • Accepted Date: 2023-03-28
  • Published Date: 2023-11-28
  •   Objective  To investigate the diagnostic efficacy and optimal cut-off values of alpha-fetoprotein (AFP) and alpha-fetoprotein variant L3 (AFP-L3) in hepatitis B virus (HBV)-related early-stage hepatocellular carcinoma (HCC).  Methods  A total of 1 080 patients with HBV-related HCC (HBV-HCC) who were diagnosed for the first time and not yet treated in The Third Affiliated Hospital of Sun Yat-Sen University from January 2019 to July 2022 were enrolled as HCC group in the study, among whom there were 620 patients with CNLC Ⅰ‍a-‍Ⅱ‍a HCC, and in addition, 346 patients with HBV-related chronic hepatitis B (CHB group) and 293 patients with HBV-related liver cirrhosis (LC group) were enrolled as controls. The diagnostic efficacy of AFP and AFP-L3% in screening for HBV-related early-stage HCC was analyzed, including sensitivity, specificity, and the area under the ROC curve (AUC). The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Bonferroni method was used for further comparison between two groups.  Results  The HCC group had significantly higher levels of AFP and AFP-L3% than the CHB group and the LC group (H=542.479 and 418.974, both P<0.001). In early-stage HCC, AFP and AFP-L3% had an optimal cut-off value of 8.7 ng/mL and 5%, respectively, and AFP alone had the largest AUC of 0.816, with a sensitivity of 66.9% and a specificity of 85.1%. There was no significant difference in AUC between AFP-L3%+AFP and AFP alone (Z=0.609, P=0.543), but both AFP-L3%+AFP and AFP alone had a significantly larger AUC than AFP-L3% alone (AFP vs AFP-L3%: Z=8.173, P<0.001; AFP+AFP-L3% vs AFP-L3%: Z=8.802, P<0.001).  Conclusion  AFP has a good value and is superior to AFP-L3% in the diagnosis of HBV-related early-stage HCC, and the screening cut-off value of AFP should be lowered in order to improve the detection rate of early-stage HCC.

     

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