Evaluation of the Combined Application of AFP, AFP-L3%, and DCP for Hepatocellular Carcinoma Diagnosis: A Meta-analysis.

Xueying Wang,Jing Jiang,Xuerong Tao,Changgui Kou,Hua He,Yangyu Zhang,Na Yang

doi:10.1155/2020/5087643

Abstract

The role of α-fetoprotein (AFP) in the surveillance and diagnosis of hepatocellular carcinoma (HCC) has been questioned in recent years due to its low sensitivity and specificity. In addition to AFP, several new serum biomarkers, such as lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) and des-gamma-carboxy prothrombin (DCP), have also been identified as useful HCC serological markers. However, the exact diagnostic value of the combinations of these biomarkers for detecting HCC in patients with liver disease remains unclear. Thus, we performed the current meta-analysis to assess performance of AFP+AFP-L3%+DCP for diagnosing HCC. Studies were systematically searched in PubMed, Embase, the Cochrane Library, CNKI, and WanFang Data databases. After full-text evaluation, 13 studies from 11 articles focusing on the combination of the three serum biomarkers for HCC detection were enrolled. Random-effects models were used due to the presence of heterogeneity. The pooled sensitivity and specificity for AFP+AFP-L3%+DCP were 88% and 79%, respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.91, and the diagnostic odds ratio (DOR) was 28.33 (95% CI 16.78-47.83). Subgroup analysis showed that the pooled sensitivity and specificity of AFP+AFP-L3%+DCP in the diagnosis of HCC versus cirrhosis patients were 0.81 and 0.82, respectively. In conclusion, the combination of AFP, AFP-L3%, and DCP may prove to be useful in the diagnosis and screening of HCC.

Highlights

With approximately 841,000 new cases and 782,000 deaths annually, hepatocellular carcinoma (HCC) is predicted to be the sixth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide [1]
The pooled positive likelihood ratio (PLR) was 4.21, and the negative likelihood ratio (NLR) was 0.15
The results suggested that the combined application of AFP+AFPL3%+des-gamma-carboxy prothrombin (DCP) might be useful for the detection for the discovery of HCC patients and clinical decision-making

Summary

Introduction

With approximately 841,000 new cases and 782,000 deaths annually, hepatocellular carcinoma (HCC) is predicted to be the sixth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide [1]. Due to the low sensitivity of ultrasound [9] and the weak ability to distinguish HCC in the background of cirrhosis [10], serum biomarkers can effectively assist the detection of cancer [11]. Some studies suggest that the combination of these biomarkers showed better performance than a single biomarker for the detection of early-stage HCC [25,26,27], the practical application of three serum markers in the screening or clinical diagnosis of HCC is still controversial. We conducted a meta-analysis to further assess the diagnostic performance of AFP+AFP-L3%+DCP and provide useful information for the application of triple biomarkers in the screening and diagnosis of HCC

Materials and Methods

Results

Discussion

Conclusions