The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Feasibility of α-fetoprotein as a diagnostic tool for hepatocellular carcinoma in Korea

  • Ahn, Dae Geon (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Hyung Joon (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kang, Hyun (Department of Anesthesiology and Pain, Chung-Ang University College of Medicine) ;
  • Lee, Hyun Woong (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Bae, Si Hyun (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Lee, Joon Hyoek (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Paik, Yong Han (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, June Sung (Department of Internal Medicine, Inje University Ilsan Paik Hospital)
  • Received : 2014.04.01
  • Accepted : 2014.10.17
  • Published : 2016.01.01
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Abstract

Background/Aims: The aim of this study was to evaluate the feasibility of ${\alpha}$-fetoprotein (AFP) as a diagnostic tool for hepatocellular carcinoma (HCC) in Korean patients. Methods: We retrospectively reviewed the medical records of HCC and cirrhosis patients at three hospitals. For each HCC patient, a cirrhosis patient matched for age, sex, etiology, and Child-Pugh classification was selected by simple random sampling. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis. Results: A total of 732 patients with HCC or cirrhosis were selected for each case and the control groups. The mean age was 54 years, and 72.4% of patients were male. The mean serum AFP levels in the HCC group and cirrhosis group were 3,315.6 and 117.2 ng/mL, respectively (p < 0.001). The area under the receiver operating characteristic curve for all HCC patients was 0.757. The sensitivity, specificity, and positive predictive value of AFP was 50.55%, 87.70%, and 80.43%, respectively, at a cut-off of 20 ng/mL; 37.70%, 95.90%, and 90.20%, respectively, at a cut-off of 100 ng/mL, and 30.05%, 97.27%, and 91.67%, respectively, at a cut-off of 200 ng/mL. A cut-off of 100 ng/mL was more sensitive than one of 200 ng/mL with equivalent specificity and positive predictive value. Conclusions: The cut-off AFP value for early-stage HCC was 17.4 ng/mL. Our study cautiously suggests that AFP has a role in the diagnosis of HCC, and that the appropriate value of AFP for the diagnosis of HCC may be 100 ng/mL rather than 200 ng/mL.

Keywords

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