title: Simplified HCC-ART score for highly sensitive detection of small-sized and early-stage hepatocellular carcinoma in the widely used Okuda, CLIP, and BCLC staging systems.
abstract: BACKGROUND
  Small-sized HCC can be effectively cured by surgery with good clinical outcomes. A highly sensitive HCC α-fetoprotein routine test (HCC-ART) for HCC diagnosis as well as a simplied form of the HCC-ART were reported in the British Journal of Cancer. Here, we verified and studied the applicability of the HCC-ART to the detection of early-stage HCC.
  
  
  METHODS
  341 cirrhotic patients and 318 HCC patients were included in this study. For each, the HCC-ART score was calculated, and then the sensitivity, specificity, and results of an ROC curve analysis were compared between the HCC-ART and AFP when these biomarkers were used to detect small-sized HCC.
  
  
  RESULTS
  Different HCC-ART cutoffs were set for the detection of different tumor sizes. The HCC-ART (AUC = 0.871, 70% sensitivity, 97% specificity) and the simplified HCC-ART (AUC = 0.934, 82% sensitivity, 100% specificity) were found to have high predictive power when attempting to separate cirrhotic patients from those with small-sized HCC. The simplified HCC-ART score was superior to AFP for determining stages according to the early Okuda (0.950 AUC, 84% sensitivity, 99% specificity), CLIP (0.945 AUC, 84% sensitivity, 99% specificity), and BCLC (1.000 AUC, 100% sensitivity, 99% specificity) staging systems. The simplified HCC-ART score was more strongly correlated than AFP and other staging systems with HCC tumor size (P < 0.0001; r = 0.8).
  
  
  CONCLUSIONS
  The HCC-ART is superior to AFP for diagnosing early-stage HCC. Due to its advantages of minimal variability and a wide continuous scale for assessing HCC severity, the simplified HCC-ART has the potential to be more widely used than the original HCC-ART.
authors.affiliation: R&D Department, Biotechnology Research Center, PO Box (14), 23 July Street, Industrial Zone, New Damietta, 34517, Egypt. amattallah@hotmail.com.
authors.forename: Abdelfattah M
authors.initials: AM
authors.lastname: Attallah
authors.affiliation: Faculty of Science, Helwan University, Cairo, Egypt.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Omran
authors.affiliation: R&D Department, Biotechnology Research Center, PO Box (14), 23 July Street, Industrial Zone, New Damietta, 34517, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Attallah
authors.affiliation: R&D Department, Biotechnology Research Center, PO Box (14), 23 July Street, Industrial Zone, New Damietta, 34517, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Abdelrazek
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Khaled
authors.initials: K
authors.lastname: Farid
authors.affiliation: Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: El-Dosoky
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins
keywords: Blood biomarkers; Diagnosis; Early stage; HCC-ART score; Hepatocellular carcinoma