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Detecting Early Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Using Longitudinal α-Fetoprotein Screening
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2022-08-27 , DOI: 10.1016/j.cgh.2022.08.018
Jonggi Choi 1 , Nabihah Tayob 2 , Young-Suk Lim 1
Affiliation  

Background & Aims

This study aimed to evaluate the parametric empirical Bayes (PEB) longitudinal α-fetoprotein (AFP) screening algorithm performance in patients with hepatitis B compared with AFP surveillance with a fixed threshold.

Methods

The serum AFP of 588 patients was measured. Patients were screened at least once every 6 months with AFP and ultrasound or computed tomography/magnetic resonance imaging. Age, aspartate aminotransferase level, alanine aminotransferase level, platelet count, total bilirubin, prothrombin time, and hepatitis B virus DNA level were adjusted in the PEB algorithm. All variables were abstracted at the time of hepatocellular carcinoma (HCC) diagnosis for cases or last follow-up for controls and at months –6, –12, –18, –24, –30, –36, –42, –48, and –54, up to month –60.

Results

Overall, 62 (10.5%) HCC cases developed during a median follow-up of 52.7 months. Moreover, 55 (88.7%) cases were detected at Barcelona Clinic Liver Cancer stage 0 or A. The area under the receiver-operating characteristic curve of the patient-level true positive rate against the screening-level false positive rate was significantly higher in the PEB algorithm than that in AFP alone (area under the receiver-operating characteristic curve: 0.94 vs 0.86; P < .0005). At 80% specificity, the PEB algorithm significantly improved the patient-level true positive rate within 2 years prior to HCC diagnosis compared with AFP alone (80.6% vs 67.7%, respectively; P = .0485; adjusted P = .1663). The PEB algorithm more effectively enabled first positive screening.

Conclusions

The longitudinal assessment of AFP by the PEB algorithm improved HCC screening performance compared to AFP alone in patients with hepatitis B. This algorithm may improve HCC screening without additional cost or inconvenience to patients.



中文翻译:

使用纵向甲胎蛋白筛查检测慢性乙型肝炎患者的早期肝细胞癌

背景与目标

本研究旨在评估参数经验贝叶斯 (PEB) 纵向甲胎蛋白 (AFP) 筛选算法在乙型肝炎患者中的性能,并与固定阈值的 AFP 监测进行比较。

方法

测定了588例患者的血清AFP。至少每 6 个月对患者进行一次 AFP 和超声或计算机断层扫描/磁共振成像筛查。在 PEB 算法中调整了年龄、天冬氨酸氨基转移酶水平、丙氨酸氨基转移酶水平、血小板计数、总胆红素、凝血酶原时间和乙型肝炎病毒 DNA 水平。所有变量都是在病例诊断为肝细胞癌 (HCC) 时或对照组最后一次随访时以及 –6、–12、–18、–24、–30、–36、–42、–48 个月时提取的。和 –54,直到一个月 –60。

结果

总体而言,62 例 (10.5%) HCC 病例在中位随访 52.7 个月期间发生。此外,在巴塞罗那临床肝癌 0 期或 A 期检测到 55 例 (88.7%) 病例。患者水平真阳性率与筛查水平假阳性率的接受者操作特征曲线下面积明显高于PEB 算法比单独使用 AFP 算法(接受者操作特征曲线下的面积:0.94 对 0.86;P < .0005)。在 80% 的特异性下,与单独使用 AFP 相比,PEB 算法在 HCC 诊断前 2 年内显着提高了患者水平的真阳性率(分别为 80.6% 和 67.7%;P = .0485;调整后的 P =  .1663  。PEB 算法更有效地实现了首次阳性筛选。

结论

与单独使用 AFP 相比,PEB 算法对 AFP 的纵向评估提高了乙型肝炎患者的 HCC 筛查性能。该算法可以改善 HCC 筛查,而不会增加成本或给患者带来不便。

更新日期:2022-08-27
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