title: Alpha-Fetoprotein Measurement Benefits Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis.
abstract: OBJECTIVE
  Liver cirrhosis is a major risk factor for hepatocellular carcinoma (HCC), and all liver study societies recommend HCC surveillance in patients with cirrhosis. However, no ideal modality for HCC surveillance has been determined. The aim of this study is to assess the effectiveness of α-fetoprotein (AFP) measurement in HCC surveillance.
  
  
  METHODS
  In this retrospective analysis, all patients with cirrhosis, who received HCC surveillance through ultrasound (US) and AFP measurement between January 2002 and July 2010, were followed up until June 2013. The performance effectiveness of surveillance using AFP, US, or both in HCC detection was compared.
  
  
  RESULTS
  Overall, 1,597 patients were followed for a median duration of 4.75 (range 1.42-12) years. Over the 8563.25-person-year follow-up period, 363 patients (22.7%) developed HCCs. For HCC detection, the area under the receiver operator characteristic curve of surveillance AFP was 0.844 (95% confidence interval: 0.820-0.868, P<0.001). When the traditional cutoff value of 20 ng/ml was used, the sensitivity and specificity of AFP were 52.9% and 93.3%, respectively. US exhibited a sensitivity and specificity of 92.0% and 74.2%, respectively. A combination of US and AFP exhibited a sensitivity and specificity of 99.2% and 68.3%, respectively. By using cut-off at 20 ng/ml and AFP level increase ≥2 × from its nadir during the previous 1 year, the combination of US and AFP yielded a sensitivity of 99.2% and an improved specificity of 71.5%.
  
  
  CONCLUSIONS
  The complementary use of AFP and US improved the effectiveness of HCC surveillance in patients with cirrhosis.
authors: 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan [3] Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Te-Sheng
authors: TS
authors: Chang
authors: Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Yu-Chih
authors: YC
authors: Wu
authors: 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Shui-Yi
authors: SY
authors: Tung
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Kuo-Liang
authors: KL
authors: Wei
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Yung-Yu
authors: YY
authors: Hsieh
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Hao-Chun
authors: HC
authors: Huang
authors: 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors: Wei-Ming
authors: WM
authors: Chen
authors: 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors: Chien-Heng
authors: CH
authors: Shen
authors: 1] Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan [2] Department of Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Chang-Hsien
authors: CH
authors: Lu
authors: 1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan [2] College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Cheng-Shyong
authors: CS
authors: Wu
authors: 1] College of Medicine, Chang Gung University, Taoyuan, Taiwan [2] Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Ying-Huang
authors: YH
authors: Tsai
authors: 1] Department of Biochemistry and Molecular Cell Biology, College of Medicine, Taipei Medical University, Taipei, Taiwan [2] Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan [3] Center for Reproductive Medicine, Taipei Medical University Hospital, Taipei, Taiwan [4] Comprehensive Cancer Center of Taipei Medical University, Taipei, Taiwan [5] Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Yen-Hua
authors: YH
authors: Huang
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins