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Early Detection of Liver Cancer Needs Reliable Biomarkers
"Most surprising was the finding that patient demographics influenced both des-gamma-carboxy prothrombin and alpha fetoprotein values, but in opposite directions," said Anna S. Lok, MD, AGAF, of the University of Michigan Medical Center and lead author of the study. "This observation merits further investigation, as it might impact the accuracy of these biomarkers in the detection of liver cancer."
The study was conducted in 10 centers in the U.S. and funded by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
Among 1,031 patients randomized in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis Trial, a nested case-control study of 39 HCC cases (24 early stage) and 77 matched controls was conducted to compare the performance of AFP and DCP. Testing was performed on serial serum samples collected during a 12-month period prior to the time of HCC diagnosis. Study results indicated that:
- The sensitivity and specificity of DCP at month 0 (at the time of HCC diagnosis) was 74 percent and 86 percent at a cutoff of 40 mAU/mL, and 43 percent and 100 percent at a cutoff of 150 mAU/mL.
- The sensitivity and specificity of AFP at month 0 was 61 percent and 81 percent at a cutoff of 20 ng/mL, and 22 percent and 100 percent at a cutoff of 200 ng/mL.
- At month -12 (12 months before the diagnosis of HCC), the sensitivity and specificity at the low cutoff was 43 percent and 94 percent for DCP, and 47 percent and 75 percent for AFP.
- Combining both markers increased the sensitivity to 91 percent at month 0 and 73 percent at month -12, but the specificity decreased to 74 percent and 71 percent.
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