Reappraisal of the diagnostic value of alpha‐fetoprotein for surveillance of HBV‐related hepatocellular carcinoma in the era of antiviral therapy
This study was designed to explore if antiviral treatment influences the performance of serum alpha‐fetoprotein (AFP) for hepatocellular carcinoma (HCC) among the high‐risk chronic HBV‐infected patients. A total of 5936 patients who had evidence of chronic HBV infection were enrolled from four indep...
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| Veröffentlicht in: | Journal of viral hepatitis 2021-01, Vol.28 (1), p.20-29 |
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| creator | Qian, Xiangjun Liu, Shuhong Long, Huiling Zhang, Siyu Yan, Xiaotong Yao, Mingjie Zhou, Jiyuan Gong, Jiao Wang, Jianwen Wen, Xiajie Zhou, Tao Zhai, Xiangwei Xu, Qiang Zhang, Ting Chen, Xiangmei Hu, Guoxin Wang, Jie Gao, Zhiliang Nan, Yuemin Chen, Junhui Hu, Bo Zhao, Jingmin Lu, Fengmin |
| description | This study was designed to explore if antiviral treatment influences the performance of serum alpha‐fetoprotein (AFP) for hepatocellular carcinoma (HCC) among the high‐risk chronic HBV‐infected patients. A total of 5936 patients who had evidence of chronic HBV infection were enrolled from four independent centres in this retrospective study, including 1721 chronic hepatitis B (CHB), 2286 liver cirrhosis (LC), 798 HCC within Milan criteria and 1131 HCC beyond Milan criteria patients. Stratified by whether they received treatment or not, the patients were further divided into antiviral and non‐antiviral groups. Then, the performance of AFP for discriminating HCC was evaluated. Patients receiving antivirals had significantly lower median levels of AFP compared with the non‐antiviral patients (P |
| doi_str_mv | 10.1111/jvh.13388 |
| format | Article |
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A total of 5936 patients who had evidence of chronic HBV infection were enrolled from four independent centres in this retrospective study, including 1721 chronic hepatitis B (CHB), 2286 liver cirrhosis (LC), 798 HCC within Milan criteria and 1131 HCC beyond Milan criteria patients. Stratified by whether they received treatment or not, the patients were further divided into antiviral and non‐antiviral groups. Then, the performance of AFP for discriminating HCC was evaluated. Patients receiving antivirals had significantly lower median levels of AFP compared with the non‐antiviral patients (P < .001), and there were significantly less patients with abnormal AFP levels in antiviral groups (P < .001). Antiviral therapy improved the AUROCs of AFP for discriminating HCC within Milan criteria. When setting the cut‐off values at 20 ng/mL and 100 ng/mL as surveillance and confirmatory tests respectively for HCC among patients receiving antiviral treatment, AFP exhibited a significantly higher sensitivity than those of 200 ng/mL and 400 ng/mL, which are currently recommended by some guidelines, without compromising specificity. Further analysis in antiviral patients revealed that serum AFP had better performance for discriminating HCC within Milan criteria in ALT ≤ 1ULN patients than that in ALT > 1ULN patients. In conclusion, in the era of antiviral therapy, serum AFP's surveillance performance was substantially improved for HCC within Milan criteria among the high‐risk population of CHB and LC patients.</description><identifier>ISSN: 1352-0504</identifier><identifier>EISSN: 1365-2893</identifier><identifier>DOI: 10.1111/jvh.13388</identifier><identifier>PMID: 32852885</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>alpha‐fetoprotein ; Antiviral agents ; Antiviral drugs ; antiviral treatment ; Chronic infection ; Cirrhosis ; Hepatitis B ; hepatitis B virus ; Hepatocellular carcinoma ; Interferon ; Liver cancer ; Liver cirrhosis ; Original ; Surveillance</subject><ispartof>Journal of viral hepatitis, 2021-01, Vol.28 (1), p.20-29</ispartof><rights>2020 The Authors. published by John Wiley & Sons Ltd</rights><rights>2020 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4438-3f25f48cec5c2e5c15a752b9f521ec51e03c9997c77b96f388d2fa0bfb0921df3</citedby><cites>FETCH-LOGICAL-c4438-3f25f48cec5c2e5c15a752b9f521ec51e03c9997c77b96f388d2fa0bfb0921df3</cites><orcidid>0000-0001-6485-0731 ; 0000-0002-0133-9837 ; 0000-0002-1832-3209 ; 0000-0003-0302-6866</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjvh.13388$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjvh.13388$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32852885$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Qian, Xiangjun</creatorcontrib><creatorcontrib>Liu, Shuhong</creatorcontrib><creatorcontrib>Long, Huiling</creatorcontrib><creatorcontrib>Zhang, Siyu</creatorcontrib><creatorcontrib>Yan, Xiaotong</creatorcontrib><creatorcontrib>Yao, Mingjie</creatorcontrib><creatorcontrib>Zhou, Jiyuan</creatorcontrib><creatorcontrib>Gong, Jiao</creatorcontrib><creatorcontrib>Wang, Jianwen</creatorcontrib><creatorcontrib>Wen, Xiajie</creatorcontrib><creatorcontrib>Zhou, Tao</creatorcontrib><creatorcontrib>Zhai, Xiangwei</creatorcontrib><creatorcontrib>Xu, Qiang</creatorcontrib><creatorcontrib>Zhang, Ting</creatorcontrib><creatorcontrib>Chen, Xiangmei</creatorcontrib><creatorcontrib>Hu, Guoxin</creatorcontrib><creatorcontrib>Wang, Jie</creatorcontrib><creatorcontrib>Gao, Zhiliang</creatorcontrib><creatorcontrib>Nan, Yuemin</creatorcontrib><creatorcontrib>Chen, Junhui</creatorcontrib><creatorcontrib>Hu, Bo</creatorcontrib><creatorcontrib>Zhao, Jingmin</creatorcontrib><creatorcontrib>Lu, Fengmin</creatorcontrib><title>Reappraisal of the diagnostic value of alpha‐fetoprotein for surveillance of HBV‐related hepatocellular carcinoma in the era of antiviral therapy</title><title>Journal of viral hepatitis</title><addtitle>J Viral Hepat</addtitle><description>This study was designed to explore if antiviral treatment influences the performance of serum alpha‐fetoprotein (AFP) for hepatocellular carcinoma (HCC) among the high‐risk chronic HBV‐infected patients. A total of 5936 patients who had evidence of chronic HBV infection were enrolled from four independent centres in this retrospective study, including 1721 chronic hepatitis B (CHB), 2286 liver cirrhosis (LC), 798 HCC within Milan criteria and 1131 HCC beyond Milan criteria patients. Stratified by whether they received treatment or not, the patients were further divided into antiviral and non‐antiviral groups. Then, the performance of AFP for discriminating HCC was evaluated. Patients receiving antivirals had significantly lower median levels of AFP compared with the non‐antiviral patients (P < .001), and there were significantly less patients with abnormal AFP levels in antiviral groups (P < .001). Antiviral therapy improved the AUROCs of AFP for discriminating HCC within Milan criteria. When setting the cut‐off values at 20 ng/mL and 100 ng/mL as surveillance and confirmatory tests respectively for HCC among patients receiving antiviral treatment, AFP exhibited a significantly higher sensitivity than those of 200 ng/mL and 400 ng/mL, which are currently recommended by some guidelines, without compromising specificity. Further analysis in antiviral patients revealed that serum AFP had better performance for discriminating HCC within Milan criteria in ALT ≤ 1ULN patients than that in ALT > 1ULN patients. In conclusion, in the era of antiviral therapy, serum AFP's surveillance performance was substantially improved for HCC within Milan criteria among the high‐risk population of CHB and LC patients.</description><subject>alpha‐fetoprotein</subject><subject>Antiviral agents</subject><subject>Antiviral drugs</subject><subject>antiviral treatment</subject><subject>Chronic infection</subject><subject>Cirrhosis</subject><subject>Hepatitis B</subject><subject>hepatitis B virus</subject><subject>Hepatocellular carcinoma</subject><subject>Interferon</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Original</subject><subject>Surveillance</subject><issn>1352-0504</issn><issn>1365-2893</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kc1u1DAUhSMEoj-w4AVQJDZ0kdY_8cTZIEEFDKgSEoJurRvnuvHIEwc7CZodj8CGF-RJcGZKBUh4Y-v687nn-mTZE0rOaVoXm7k7p5xLeS87pnwlCiZrfn85C1YQQcqj7CTGDSGUM0EfZkecScGkFMfZj48IwxDARnC5N_nYYd5auOl9HK3OZ3ATLnVwQwc_v303OPoh-BFtnxsf8jiFGa1z0Os9t351naiADkZs8w4HGL1G5yYHIdcQtO39FvL0eumEAfbi_WhnG5KDVAww7B5lDwy4iI9v99Ps85vXny7XxdWHt-8uX14Vuiy5LLhhwpRSoxaaodBUQCVYUxvBaKpRJFzXdV3pqmrqlUkf1DIDpDENqRltDT_NXhx0h6nZYquxH5MLNQS7hbBTHqz6-6a3nbrxs6oqsapqmgSe3woE_2XCOKqtjcu80KOfomIlr6QgtBQJffYPuvFT6NN4iapIWXPGZaLODpQOPsaA5s4MJWoJW6Ww1T7sxD790_0d-TvdBFwcgK_W4e7_Sur99fog-QsOG7ms</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Qian, Xiangjun</creator><creator>Liu, Shuhong</creator><creator>Long, Huiling</creator><creator>Zhang, Siyu</creator><creator>Yan, Xiaotong</creator><creator>Yao, Mingjie</creator><creator>Zhou, Jiyuan</creator><creator>Gong, Jiao</creator><creator>Wang, Jianwen</creator><creator>Wen, Xiajie</creator><creator>Zhou, Tao</creator><creator>Zhai, Xiangwei</creator><creator>Xu, Qiang</creator><creator>Zhang, Ting</creator><creator>Chen, Xiangmei</creator><creator>Hu, Guoxin</creator><creator>Wang, Jie</creator><creator>Gao, Zhiliang</creator><creator>Nan, Yuemin</creator><creator>Chen, Junhui</creator><creator>Hu, Bo</creator><creator>Zhao, Jingmin</creator><creator>Lu, Fengmin</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6485-0731</orcidid><orcidid>https://orcid.org/0000-0002-0133-9837</orcidid><orcidid>https://orcid.org/0000-0002-1832-3209</orcidid><orcidid>https://orcid.org/0000-0003-0302-6866</orcidid></search><sort><creationdate>202101</creationdate><title>Reappraisal of the diagnostic value of alpha‐fetoprotein for surveillance of HBV‐related hepatocellular carcinoma in the era of antiviral therapy</title><author>Qian, Xiangjun ; 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A total of 5936 patients who had evidence of chronic HBV infection were enrolled from four independent centres in this retrospective study, including 1721 chronic hepatitis B (CHB), 2286 liver cirrhosis (LC), 798 HCC within Milan criteria and 1131 HCC beyond Milan criteria patients. Stratified by whether they received treatment or not, the patients were further divided into antiviral and non‐antiviral groups. Then, the performance of AFP for discriminating HCC was evaluated. Patients receiving antivirals had significantly lower median levels of AFP compared with the non‐antiviral patients (P < .001), and there were significantly less patients with abnormal AFP levels in antiviral groups (P < .001). Antiviral therapy improved the AUROCs of AFP for discriminating HCC within Milan criteria. When setting the cut‐off values at 20 ng/mL and 100 ng/mL as surveillance and confirmatory tests respectively for HCC among patients receiving antiviral treatment, AFP exhibited a significantly higher sensitivity than those of 200 ng/mL and 400 ng/mL, which are currently recommended by some guidelines, without compromising specificity. Further analysis in antiviral patients revealed that serum AFP had better performance for discriminating HCC within Milan criteria in ALT ≤ 1ULN patients than that in ALT > 1ULN patients. 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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | alpha‐fetoprotein Antiviral agents Antiviral drugs antiviral treatment Chronic infection Cirrhosis Hepatitis B hepatitis B virus Hepatocellular carcinoma Interferon Liver cancer Liver cirrhosis Original Surveillance |
| title | Reappraisal of the diagnostic value of alpha‐fetoprotein for surveillance of HBV‐related hepatocellular carcinoma in the era of antiviral therapy |
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