Serum AFP,AFP-l3 And DCP Combined Detection For Primary Hepatocellular Carcinoma Diagnosis:A Meta-analysis And A Retrospective Study

To evaluate the diagnostic value of combination detection of AFP?AFP-L3 and DCP in patients with primary hepatocellular carcinoma by Meta-analysis and a retrospective study.Methods1.Retrospective study on 152 hepatitis,146 cirrhotic patients and 270 patients with hepatocellular carcinoma in The Second Affiliated Hospital of Chong Qing Medical University.The levels of AFP,DCP and AFP-L3% serum were analyzed..2.Diagnostic studies related to combination detection of serum AFP,AFP-L3% and DCP in patients with primary hepatocellular were electronic searched in the databases of PubMed,Cochrane,Medline,CNKI,Wang Fang data,CQVIP by reviewers.A meta-analysis was performed using Stata12.0,MetaDiSc and RevManResults1.When AFP,DCP,and AFP-L3% were used as the individual tumor marker,the areas under the receiver operating characteristic curve(AUROC)for HCC diagnosis were 0.789(95%CI,0.751~0.828),0.928(95% CI: 0.905~0.951),0.738(95%CI:0.695~0.7),the sensitivities were 78.15%,88.52%,66.67%,the specificities were 55.7%,77.85%,84.56%.The AFP,DCP and AFP-L3 were used as the combined tumor marker,the AUROC were 0.926(95%CI: 0.902~0.949),the sensitivity and specificity were 92.96%,46.98%.2.Twelve studies were included in this meta-analysis.The pooled diagnostic sensitivity(Sen),specificity(Spe),positive likely hood ratio(PLR),negative likely hood ratio(NLR),diagnostic odds ratio(DOR),and AUC were0.916(95%CI:0.851~0.954),0.734(95%CI:0.647~0.806),3.447(95%CI:2.585~4.596),0.114(95%CI:0.065~0.200),30.232(95%CI:16.039~56.987),0.89(95%CI:0.86~0.92),the indices of Sen,Spe,PLR,NLR,DOR,AUC of the marker AFP were 0.644(95%CI:0.591~0.693),0.875(95%CI: 0.804~ 0.923),5.165(95%CI:3.361~7.935),0.407(95%CI:0.362~0.459),12.683(95%CI: 8.104~19.847),0.77(95%CI:1.00~0.00),the indices of Sen,Spe,PLR,NLR,DOR,AUC of the marker AFP-L3% were 0.581(95% CI:0.496,0.661),0.865(95%CI:0.826,0.896),4.305(95%CI:3.756,4.934),0.484(95%CI:0.412,0.569),8.886(95%CI:7.860,10.046),0.83(95%CI:0.79-0.86),the indices of Sen,Spe,PLR,NLR,DOR,AUC of the marker DCP were 0.722(95%CI:0.625~0.803),0.900(95%CI:0.840~0.939),7.202(95% CI: 4.655~11.142),0.308(95%CI:0.228~0.417),23.345(95%CI:14.078,38.714),0.89(95%CI:0.86~0.91).Conclusion: 1 The combination of markers had the best Sensitivity,This is good for early detection of primary hepatocellular carcinoma.2 DCP was the most useful single biomarker for diagnosing PHC,It had high sensitivity,specificity and accuracy.3.The combination of three tumor markers including AFP,DCP and AFP-L3 showed better accuracy than AFP and AFP-L3 in diagnosing PHC,but there is no difference between a combination of three tumor markers and DCP alone,in order to get further conclusions,we need higher quality meta-analysis or clinical studies.