Efficient detection of hepatocellular carcinoma by a hybrid blood test of epigenetic and classical protein markers.
BACKGROUND
There are few blood tests for an efficient detection of hepatocellular carcinoma (HCC) associated with hepatitis C virus (HCV) infection.


METHODS
The abilities of quantitative analyses of 7 genes hypermethylation in serum DNA, α-fetoprotein (AFP) and prothrombin-induced vitamin K absence II (PIVKA-II), and various combinations to detect HCC were evaluated in a training cohort of 164 HCV-infected patients (108 HCCs; 56 non-HCCs). An optimal hybrid detector, built using data for 2 methylated genes (SPINT2 and SRD5A2), AFP, and PIVKA-II, achieved the most satisfactory ability to detect HCC in the training cohort. We evaluated the ability of the optimal hybrid detector to detect HCC in an independent validation cohort of 258 consecutive HCV-infected patients (112 HCCs; 146 non-HCCs) who were newly enrolled in 4 distinct institutes.


RESULTS
In the validation cohort of 258 patients, accuracy, sensitivity, and specificity of the hybrid detector for detection of HCC were 81.4%, 73.2%, and 87.7%, respectively. Notably, even when detecting HCC ≤ 2 cm in diameter, the hybrid detector maintained markedly high abilities (84.6% accuracy, 72.2% sensitivity, 87.7% specificity). Youden's index (sensitivity+specificity - 1) for HCC ≤ 2cm was 0.60, vastly much superior to the 0.39 for AFP at a cut-off value of 20 ng/ml and the 0.28 for PIVKA-II at a cut-off value of 40 mAU/ml.


CONCLUSIONS
These results show that the optimal hybrid blood detector can detect HCV-related HCC more accurately.
Iizuka
Norio
N
Departments of Surgery II Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan.
Oka
Masaaki
M
Sakaida
Isao
I
Moribe
Toyoki
T
Miura
Toshiaki
T
Kimura
Naoki
N
Tamatsukuri
Shigeru
S
Ishitsuka
Hideo
H
Uchida
Koichi
K
Terai
Shuji
S
Yamashita
Satoyoshi
S
Okita
Kiwamu
K
Sakata
Koichiro
K
Karino
Yoshiyasu
Y
Toyota
Joji
J
Ando
Eiji
E
Ide
Tatsuya
T
Sata
Michio
M
Tsunedomi
Ryoichi
R
Tsutsui
Masahito
M
Iida
Michihisa
M
Tokuhisa
Yoshihiro
Y
Sakamoto
Kazuhiko
K
Tamesa
Takao
T
Fujita
Yusuke
Y
Hamamoto
Yoshihiko
Y
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D001774:Blood Chemical Analysis / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D019175:DNA Methylation; D044127:Epigenesis, Genetic; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D015203:Reproducibility of Results; D000509:alpha-Fetoproteins / Q000032:analysis*
D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin