Correlation of Abdominal CT scan Score and Alpha-fetoprotein Levels in Hepatocellular Carcinoma
Indira Prawita Martani, Firman Sitanggang, Ni Margiani, I Gde Widiana, Made Asih, I Made Ayusta
Abstract
Objective: To assess the correlation between the Alpha-fetoprotein (AFP) level and characteristics of liver lesions listed in the abdominal computed tomography (CT) scan scores in hepatocellular carcinoma.
Methods: This was a retrospective analytic observational study with a cross-sectional design conducted at Sanglah Hospital in January 2017–January 2021. Subjects were patients diagnosed with hepatocellular carcinoma based on clinical and laboratory features. Samples were taken by consecutive sampling. The results of the abdominal CT scan were read by two radiologists with a predetermined abdominal CT scan scoring system. The AFP level data were taken at a maximum of 5 days before an abdominal CT scan was performed.
Results: A total of 64 subjects were included in this study. The mean serum AFP level was 1,000 IU/mL (range 0.54–61830 IU/mL). The mean abdominal CT scan score by examiner one was 10.093±5.59, while the examiner two provided a score of 10.281±5.45. The difference in mean CT scan scores between the two examiners was very low and insignificant (mean difference score -0.188; 95% CI -1.894–1.519). The rho Spearman value was 0.918 (p<0.001) between serum AFP levels and abdominal CT scan scores. In the partial correlation, the value of r=0.678 (p<0.001) was obtained after controlling for body mass index (BMI), age, and sex variables.
Conclusions: There is a strong positive correlation between serum AFP levels and abdominal CT scan scores in hepatocellular carcinoma patients. Further research is needed with a prospective design to reduce research bias.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
Petrick JL, Florio AA, Znaor A, Ruggieri D, Laversanne M, Alvarez CS, et al. International trends in hepatocellular carcinoma incidence, 1978–2012. Int J Cancer. 2020;147(2):317–30.
Chen F, Freyer C, Gong L, Zekry A. Hepatitis B Virus, Hepatitis C Virus, the microbiome, and hepatocellular carcinoma. In: gastrointestinal diseases and their associated infections. Elsevier Health Sci; 2019:41–50.
Jarnagin WR. Blumgart’s surgery of the liver, biliary tract and pancreas, 2-volume set. In: Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas, 2-Volume Set. Elsevier; 2017:iv.
Leerapun A, Suravarapu SV, Bida JP, Clark RJ, Sanders EL, Mettler TA, et al. The utility of lens culinaris agglutinin-reactive α-fetoprotein in the diagnosis of hepatocellular carcinoma: evaluation in a United States referral population. Clin Gastroenterol Hepatology. 2007;5(3):394–402.
Tarocchi M, Galli A. Oxidative stress as a mechanism for hepatocellular carcinoma. in: liver pathophysiology. Elsevier; 2017:279–87.
Roberts LR, Sirlin CB, Zaiem F, Almasri J, Prokop LJ, Heimbach JK, et al. Imaging for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis. Hepatol. 2018;67(1):401–21.
He J, Shi J, Fu X, Mao L, Zhou T, et al. The clinicopathologic and prognostic significance of gross classification on solitary hepatocellular carcinoma after hepatectomy. Medicine (Baltimore). 2015;94(32):e1331.
Huang T-S, Shyu Y-C, Turner R, Chen H-Y, Chen P-J. Diagnostic performance of alpha-fetoprotein, lens culinaris agglutinin-reactive alpha-fetoprotein, des-gamma carboxyprothrombin, and glypican-3 for the detection of hepatocellular carcinoma: a systematic review and meta-analysis protocol. Syst Rev. 2013;2(1):37.
Suriapranata IM, Sudania WM, Tjong WY, Suciptan AA, Gani RA, Hasan I, et al. Alpha-fetoprotein gene polymorphisms and risk of HCC and cirrhosis. Clin Chim Acta. 2010;411(5-6):351–58.
Ge T, Shen Q, Wang N, Zhang Y, Ge Z, Chu W, et al. Diagnostic values of alpha-fetoprotein, dickkopf-1, and osteopontin for hepatocellular carcinoma. Med Oncol. 2015;32(3):59.
Toyoda H, Kumada T, Tada T, Sone Y, Kaneoka Y, Maeda A. Tumor Markers for Hepatocellular Carcinoma: Simple and Significant Predictors of Outcome in Patients with HCC. Liver Cancer. 2015;4(2):126–36.
Soetikno RD, Hatta I, Santiana L, Dewi DK. Correlation between alpha fetoprotein (afp) levels and characteristics of liver lesions using computed tomography (CT) scan in Karsinoma hepatoseluler: a Study at Dr. Hasan Sadikin Central General Hospital Bandung 2019. Innov J Med Heal Sci. 2020;10(7):1128–33.
Hsu CY, Liu PH, Lee YH, Hsia CY, Huang YH, Lin HC, et al. Using serum α-fetoprotein for prognostic prediction in patients with hepatocellular carcinoma: what is the most optimal cutoff?. PLoS One. 2015;10(3):e0118825.
McGlynn KA, Petrick JL, El‐Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology. 2021;73(S1):4–13.
Yang H, Xuefeng Y, Jianhua X. Systematic review of the roles of interleukins in hepatocellular carcinoma. Clin Chim Acta. 2020;506:33–43.
Chou WC, Lee CL, Yang TS, Huang CY, Teng W, Tseng YT, et al. Changes in serum α-fetoprotein level predicts treatment response and survival in hepatocellular carcinoma patients and literature review. J Formos Med Assoc. 2018;117(2):153–63.
Wang W, Wei C. Advances in the early diagnosis of hepatocellular carcinoma. Genes Dis. 2020;7(3):308–19.
Fowler KJ, Potretzke TA, Hope TA, Costa EA, Wilson SR. LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma. Abdom Radiol. 2018;43(1):149–57.
