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Improving screening for hepatocellular carcinoma

The latest issue of Clinical Gastroenterology & Hepatology reports improved screening for hepatocellular carcinoma by incorporating data on levels of α-fetoprotein.

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Current screening algorithms for hepatocellular carcinoma view each testing interval independently, without considering prior test results.

Dr Elliot Lee from Michigan USA investigated whether measurements of α-fetoprotein, over time, can be used to identify patients most likely to develop hepatocellular carcinoma.

The team performed a nested case-control study using data from subjects in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis trial.

The research team matched 82 patients with hepatocellular carcinoma to individuals without hepatocellular carcinoma, using bootstrap methods to ensure similar follow-up times between groups.

The team assessed the independent association between development of hepatocellular carcinoma and the following: most recent level of α-fetoprotein, standard deviation in level of α-fetoprotein, and rate of increase in α-fetoprotein using a multiple logistic regression that included patient-specific risk factors such as age, platelet count, and smoking status.

All 3 α-fetoprotein metrics were associated with hepatocellular carcinoma development
Clinical Gastroenterology and Hepatology

The research team noted that in bivariable analysis, all 3 α-fetoprotein metrics were associated with hepatocellular carcinoma development.

The most strongly associated metric was the standard deviation of α-fetoprotein.

Incorporating the standard deviation of  and rate of α-fetoprotein increase, along with patient-specific risk factors, improved the prognostic accuracy to an area under the receiver-operating characteristic curve of 0.81, compared with 0.76 when only the most recent α-fetoprotein level was used.

Dr Elliot's team commented, "Patterns of α-fetoprotein test results can more accurately identify patients with hepatitis C and advanced fibrosis or cirrhosis most likely to develop hepatocellular carcinoma, compared with most recent α-fetoprotein test results."

Clin Gastroenterol Hepatol 2013: 11(4): 437-440
29 March 2013

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