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Development And Validation Of A Simple Model For Detection Of Early Hepatocellular Carcinoma In A Liver Cirrhosis Cohort

Authors Li T, Li H, Wang A, Su X, Zhao J, Cui Y, Liu J, Hu J

Received 27 June 2019

Accepted for publication 23 October 2019

Published 5 November 2019 Volume 2019:11 Pages 9379—9386

DOI https://doi.org/10.2147/CMAR.S221050

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Ahmet Emre Eskazan


Tao Li,1,* Hongguang Li,2,* Aihua Wang,3 Xiaoyan Su,1 Jingfang Zhao,1 Yi Cui,1 Jun Liu,4 Jinhua Hu1

1Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China; 2Shandong University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China; 3Department of Gastroenterology, Linyi People’s Hospital, Linyi, Shandong, People’s Republic of China; 4Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jinhua Hu
Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Road, Ji’nan 250021, Shandong Province, People’s Republic of China
Tel +86-531-68773299
Email 15665783658@163.com
Jun Liu
Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing 5 Road, Jinan, People’s Republic of China
Tel +86-531-68773299
Email dr_liujun1967@yeah.net

Aim: We aimed to develop a simple model combining protein induced by vitamin K antagonist-II (PIVKA-II) and alpha-fetoprotein (AFP) to detect early hepatocellular carcinoma (HCC) in liver cirrhosis (LC) patients.
Method: One hundred and sixty-nine newly diagnosed early HCC patients and 242 LC patients without HCC were enrolled in the current case-control study. All subjects were randomly divided into analysis group and validation group. Serum levels of PIVKA-II, AFP and other laboratory parameters were detected. Chi-squared test, t-test and logistic regression were employed in statistical analysis.
Results: PIVKA-II level in early HCC was significantly higher than that in LC (90.97 mAU/mL vs 18.00 mAU/mL, P < 0.01), as well as AFP level (15.00 ng/mL vs 2.00 ng/mL, P < 0.01) in analysis groups. Multivariate analysis showed that PIVAK-II, AFP, gender, and age were independent risk factors for early HCC detection among LC patients. A logistic regression model and a simple model combining PIVKA and AFP were conducted to detect early HCC. The ROC curve showed that among analysis groups, the area under the ROC curve (AUROC) of the logistic regression model and the simple model were 0.96 (95% CI 0.94–0.98) and 0.94 (95% CI 0.92–0.97), respectively. At a cut-off value of 56.03 the sensitivity and specificity of the simple model were 81.1% and 91.4%, respectively. In the validation group, the sensitivity and specificity of the simple model was 82.4% and 94.2%, respectively. The two models are comparable statistically for early HCC detection, but the logistic regression requires complex calculation.
Conclusion: The present study indicates that the simple model combining PIVKA-II and AFP has comparable diagnostic efficiency in contrast to the logistic model but is easy to use clinically. It might be helpful for early HCC detection among liver cirrhosis patients.

Keywords: hepatocellular carcinoma, PIVKA-II, AFP, liver cirrhosis

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