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."