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Reappraisal of serum alpha‐foetoprotein as a surveillance test for hepatocellular carcinoma during entecavir treatment
Author(s) -
Kim GiAe,
Seock Chang Hyeon,
Park Jang Won,
An Jihyun,
Lee KwangSun,
Yang Jee Eun,
Lim YoungSuk,
Kim Kang Mo,
Shim Ju Hyun,
Lee Danbi,
Lee Han Chu
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12516
Subject(s) - hepatocellular carcinoma , medicine , entecavir , cirrhosis , gastroenterology , incidence (geometry) , hepatitis b virus , chronic hepatitis , hepatitis b , receiver operating characteristic , multivariate analysis , predictive value , virus , immunology , lamivudine , physics , optics
Background & Aims The aim of this study was to re‐evaluate the diagnostic performance of alpha‐foetoprotein ( AFP ) as a surveillance test for hepatocellular carcinoma ( HCC ) in patients with hepatitis B virus‐related chronic liver disease who were treated with entecavir ( ETV ). Methods Between January 2007 and August 2012, we analysed 373 treatment‐naïve patients with HBV ‐related chronic hepatitis ( n = 229) or cirrhosis ( n = 144) who were candidates for surveillance test, and were treated with ETV (0.5 mg/day) for longer than 12 months. To minimize the effect of AFP elevation caused by hepatitis activity, serum AFP levels were measured 12 months after the initiation of ETV treatment. Results Hepatocellular carcinoma developed in 28 patients (7.5%) during a median follow‐up period of 48.0 months (IQR = 40.5–57.3 months). The area under the receiver operating characteristic curve for AFP was 0.71 (95% CI = 0.59–0.84). The optimal AFP cut‐off value was 13 ng/ml, leading to a sensitivity of 50.0%, specificity of 98.8%, positive predictive value of 77.8% and negative predictive value of 96.1%. In multivariate Cox analysis, an older age, the presence of cirrhosis and AFP levels of ≥20 ng/ml at 12 months after treatment were found to be significantly associated with an increased incidence of HCC. Conclusions The role of serum AFP as a surveillance test should be re‐evaluated in patients with HBV ‐related chronic liver diseases who were treated with antiviral therapy.