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Reappraisal of the diagnostic value of alpha‐fetoprotein for surveillance of HBV‐related hepatocellular carcinoma in the era of antiviral therapy
Author(s) -
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
Publication year - 2021
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.13388
Subject(s) - hepatocellular carcinoma , medicine , antiviral therapy , gastroenterology , cirrhosis , alpha fetoprotein , antiviral treatment , milan criteria , chronic hepatitis , entecavir , hepatitis b , immunology , virus , liver transplantation , lamivudine , transplantation
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.