title: Assessment of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma in Middle Eastern patients.
abstract: BACKGROUND
  Alpha-fetoprotein (AFP) levels for the diagnosis of hepatocellular carcinoma (HCC) may vary by geographical region and racial background. No data exists for this test in the Middle Eastern population. In addition, there is limited data on the impact of virological status on AFP levels.
  
  
  METHODS
  In a multicenter, case-control study involving 206 cases, 199 cirrhotic and 197 chronic hepatitis controls, we assessed the utility of AFP in the diagnosis of HCC (sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and positive likelihood ratios (LR). PPV and NPV were evaluated for three additional HCC prevalence rates (5, 10, and 20%).
  
  
  RESULTS
  The best discriminating AFP value was 11.7 ng/ml. The sensitivity ranged from 32 to 79.5% at different AFP levels with the specificity increasing sequentially from 47.7 to 98.5%. Sensitivity of AFP at the best cut-off level for hepatitis C virus (HCV), hepatitis B virus (HBV) and non-viral etiology for HCC was 73.7, 65.6, and 59.5%, respectively. Specificity at this level for HCV, HBV, and non-viral etiology was 36.6, 30.1, and 29.4%, respectively. AFP cut-off levels of 102, 200, and 400 ng/ml showed similar sensitivity (39.8, 35.9, and 32%, respectively) and specificity (96, 98.5, and 98.5% respectively). Positive LR for AFP at >11.7, >20, >102, >200, >400 ng/ml were 2.8, 3.3, 9.9, 23.8, and 21.2, respectively.
  
  
  CONCLUSIONS
  In cirrhotic patients, AFP has a poor screening and diagnostic value for HCC. Underlying viral etiology fails to influence the diagnostic accuracy of this test. An AFP level greater than 100 ng/ml has a high degree of specificity and may be used as a confirmatory test.
authors.affiliation: Department of Gastroenterology, Riyadh Military Hospital A41, PO Box 7897, Riyadh 11159, Saudi Arabia. fsanai@rmh.med.sa
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Sanai
authors.forename: Samia
authors.initials: S
authors.lastname: Sobki
authors.forename: Khalid I
authors.initials: KI
authors.lastname: Bzeizi
authors.forename: Shaffi A
authors.initials: SA
authors.lastname: Shaikh
authors.forename: Khalid
authors.initials: K
authors.lastname: Alswat
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-Hamoudi
authors.forename: Majid
authors.initials: M
authors.lastname: Almadi
authors.forename: Faisal
authors.initials: F
authors.lastname: Al Saif
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Abdo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood*; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D006521:Hepatitis, Chronic / Q000175:diagnosis; D006525:Hepatitis, Viral, Human / Q000175:diagnosis; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis; D008113:Liver Neoplasms / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012529:Saudi Arabia; D012680:Sensitivity and Specificity; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins
references.citation: Ann Intern Med. 2003 Jul 1;139(1):46-50
references.pmid: 12834318
references.citation: Am J Gastroenterol. 1995 Jan;90(1):15-23
references.pmid: 7801921
references.citation: Cancer. 1996 Sep 1;78(5):977-85
references.pmid: 8780534
references.citation: World J Gastroenterol. 2006 Nov 21;12(43):7019-24
references.pmid: 17109498
references.citation: Scand J Gastroenterol. 1993 Jun;28(6):540-4
references.pmid: 7686686
references.citation: Hepatology. 2000 Feb;31(2):330-5
references.pmid: 10655254
references.citation: Cancer. 1980 Apr 15;45(7 Suppl):1755-61
references.pmid: 6154517
references.citation: J Hepatol. 1992 Mar;14(2-3):401-3
references.pmid: 1323603
references.citation: Hepatology. 2000 Oct;32(4 Pt 1):842-6
references.pmid: 11003632
references.citation: J Hepatol. 2001 Apr;34(4):603-5
references.pmid: 11394662
references.citation: Hepatology. 2005 Nov;42(5):1208-36
references.pmid: 16250051
references.citation: Liver. 1986 Jun;6(3):133-7
references.pmid: 2427909
references.citation: J Hepatol. 1998 Dec;29(6):944-52
references.pmid: 9875641
references.citation: Cancer Res. 1974 Jan;34(1):244-7
references.pmid: 4809461
references.citation: N Engl J Med. 1991 Sep 5;325(10):675-80
references.pmid: 1651452
references.citation: Scand J Clin Lab Invest. 1956;8(2):174
references.pmid: 13351554
references.citation: JAMA. 1975 Jul 7;233(1):38-41
references.pmid: 48562
references.citation: Am J Gastroenterol. 2006 Mar;101(3):524-32
references.pmid: 16542289
references.citation: Int J Cancer. 1968 May 15;3(3):364-73
references.pmid: 4176107
references.citation: Ann Surg. 1995 Sep;222(3):375-80; discussion 380-3
references.pmid: 7677466
references.citation: Acta Med Okayama. 2002 Dec;56(6):317-20
references.pmid: 12685861
references.citation: Anticancer Res. 2003 Mar-Apr;23(2C):1747-53
references.pmid: 12820452
references.citation: Ann Saudi Med. 2006 Jul-Aug;26(4):261-5
references.pmid: 16880728
references.citation: Korean J Gastroenterol. 2006 Nov;48(5):321-6
references.pmid: 17132920
references.citation: J Hepatol. 2001 Sep;35(3):421-30
references.pmid: 11592607
references.citation: Br J Cancer. 1994 Jun;69(6):1157-9
references.pmid: 7515263
references.citation: J Hepatol. 2001 Apr;34(4):570-5
references.pmid: 11394657
references.citation: Am J Gastroenterol. 1998 Dec;93(12):2452-6
references.pmid: 9860408
references.citation: Hepatology. 2003 Mar;37(3):520-7
references.pmid: 12601348
references.citation: Hepatology. 2002 Aug;36(2):410-7
references.pmid: 12143050
references.citation: Liver Transpl. 2000 May;6(3):320-5
references.pmid: 10827233