title: Reappraisal of serum alpha-foetoprotein as a surveillance test for hepatocellular carcinoma during entecavir treatment.
abstract: OBJECTIVE
  The aim of this study was to re-evaluate the diagnostic performance of alpha-foetoprotein (AFP) as a surveillance test for hepatocellular carcinoma (HCC) in patients with hepatitis B virus-related chronic liver disease who were treated with entecavir (ETV).
  
  
  METHODS
  Between January 2007 and August 2012, we analysed 373 treatment-naïve patients with HBV-related chronic hepatitis (n = 229) or cirrhosis (n = 144) who were candidates for surveillance test, and were treated with ETV (0.5 mg/day) for longer than 12 months. To minimize the effect of AFP elevation caused by hepatitis activity, serum AFP levels were measured 12 months after the initiation of ETV treatment.
  
  
  RESULTS
  Hepatocellular carcinoma developed in 28 patients (7.5%) during a median follow-up period of 48.0 months (IQR = 40.5-57.3 months). The area under the receiver operating characteristic curve for AFP was 0.71 (95% CI = 0.59-0.84). The optimal AFP cut-off value was 13 ng/ml, leading to a sensitivity of 50.0%, specificity of 98.8%, positive predictive value of 77.8% and negative predictive value of 96.1%. In multivariate Cox analysis, an older age, the presence of cirrhosis and AFP levels of ≥20 ng/ml at 12 months after treatment were found to be significantly associated with an increased incidence of HCC.
  
  
  CONCLUSIONS
  The role of serum AFP as a surveillance test should be re-evaluated in patients with HBV-related chronic liver diseases who were treated with antiviral therapy.
authors.affiliation: Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Gi-Ae
authors.initials: GA
authors.lastname: Kim
authors.forename: Chang Hyeon
authors.initials: CH
authors.lastname: Seock
authors.forename: Jang Won
authors.initials: JW
authors.lastname: Park
authors.forename: Jihyun
authors.initials: J
authors.lastname: An
authors.forename: Kwang-Sun
authors.initials: KS
authors.lastname: Lee
authors.forename: Jee Eun
authors.initials: JE
authors.lastname: Yang
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Lim
authors.forename: Kang Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Shim
authors.forename: Danbi
authors.initials: D
authors.lastname: Lee
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
mesh_terms: D000328:Adult; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins; C413685:entecavir; D006147:Guanine
keywords: alpha-foetoprotein; entecavir; hepatocellular carcinoma