Risk Evaluation Of Primary Hepatocellular Carcinoma Presence By Fibro Touch,Alpha-fetoprotein And Fibrinogen

Objective: to compare the levels of liver stiffness measurement and fat attenuation parameter using Fibro Touch,alpha-fetoprotein and plasma fibrinogen among hepatocellular carcinoma group,cirrhosis group and chronic hepatitis group,and analyze the effects of four indexes on the occurrence of primary hepatocellular carcinoma in order to detect early and guide the clinical diagnosis and treatment of hepatocellular carcinoma.Methods: a total of 491 inpatients were enrolled in the study from the hepatology department,the first hospital of Jilin University from November 2015 to November 2017,including 150 cases of primary liver cancer with the first diagnosis,84 cases of liver cirrhosis and 257 cases of chronic hepatitis.Basic information such as gender,age and body mass index(BMI)were collected.Venous blood samples were collected within 48 hours after admission for the following items: hemoglobin(HGB),platelet(PLT),international standardized ratio(INR),fibrinogen(FBG),alanine aminotransferase(ALT),aspertate aminotransferase(AST),gamma glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),serum albumin(ALB),total bilirubin(TBIL),alpha fetoprotein(AFP),HBV/HCV etiological markers and other indicators.Liver stiffness measurement(LSM)and fat attenuation parameter(FAP)were obtained by Fibro Touch.A case-control study was adopted in this study.Results: 1.Univariate analysis showed that influence factors of primary liver cancer included gender,age,FAP,INR,FBG,ALT,ALP,ALB,AFP.Multivariate binary logistic regression analysis showed that male,age ? 50 years old,FBG,AFP ? 200ng/ml were independent risk factors for HCC,FAP was the protective factor,and LSM was not an independent factor.2.Comparison of LSM,FAP,FBG,AFP among chronic hepatitis group,cirrhosis group and hepatocellular carcinoma group: the level of LSM was the highest in cirrhosis group,and the difference among the three groups was statistically significant(P<0.001).FAP,FBG and AFP were significantly different between hepatocellular carcinoma group and chronic hepatitis group,cirrhosis group.FAP was the lowest in hepatocellular carcinoma group(P<0.05),FBG and AFP were the highest in hepatocellular carcinoma group(P<0.001).There was no significant difference for FAP,FBG and AFP between chronic hepatitis group and cirrhosis group(P>0.05).We divided further hepatocellular carcinoma group into hepatocellular carcinoma with cirrhosis group and without cirrhosis group.The results showed that the level of LSM was the highest in cirrhosis group,there was no significant difference between chronic hepatitis group and hepatocellular carcinoma without cirrhosis group,but there was significant difference among the other groups(P<0.05).FAP was the lowest in hepatocellular carcinoma with cirrhosis group,there were significant differences between hepatocellular carcinoma with cirrhosis group and chronic hepatitis group,between hepatocellular carcinoma with cirrhosis group and cirrhosis group(P < 0.05).However,there were no difference between hepatocellular carcinoma with cirrhosis group and hepatocellular carcinoma without cirrhosis group,between hepatocellular carcinoma without cirrhosis group and chronic hepatitis group,between hepatocellular carcinoma without cirrhosis group and cirrhosis group.The level of FBG was the highest in hepatocellular carcinoma without cirrhosis group,there were significant differences between chronic hepatitis group and hepatocellular carcinoma with cirrhosis group,hepatocellular carcinoma without cirrhosis group,between cirrhosis group and hepatocellular carcinoma with cirrhosis group,hepatocellular carcinoma without cirrhosis group(P < 0.01),but there were no significant difference between hepatocellular carcinoma with cirrhosis group and hepatocellular carcinoma without cirrhosis group.AFP level was the highest in hepatocellular carcinoma with cirrhosis group,there were significant differences between chronic hepatitis group and hepatocellular carcinoma with cirrhosis group,hepatocellular carcinoma without cirrhosis group,between cirrhosis group and hepatocellular carcinoma with cirrhosis group(P < 0.01).However,there were no significant difference between cirrhosis group and hepatocellular carcinoma without cirrhosis group,between hepatocellular carcinoma with cirrhosis group and hepatocellular carcinoma without cirrhosis group.We further divided the patients with liver cirrhosis into compensated group and decompensated group,and the patients with liver cancer were divided into early liver cancer group and middle-late liver cancer group.The results showed that the level of LSM was the highest in decompensated cirrhosis group.There was a significant difference between early liver cancer group and decompensated cirrhosis group,between middle-late liver cancer group and decompensated cirrhosis group(P < 0.001).The level of FAP was the lowest in early liver cancer group.There was no significant difference among the three groups(P =0.077).The level of FBG was the highest in middle-late liver cancer group,and there was significant difference between early liver cancer group and compensated cirrhosis group,decompensated cirrhosis group,between middle-late liver cancer group and compensated cirrhosis group,decompensated cirrhosis group(P < 0.001).AFP level was the highest in middle-late liver cancer group,and there was significant difference between middle-late liver cancer group and compensated cirrhosis group,decompensated cirrhosis group(P < 0.001).There was no significant difference in the four indexes between compensated cirrhosis group and decompensated cirrhosis group,between early liver cancer group and middle-late liver cancer group.3.There was no correlation between FAP and Child-Pugh grade(P = 0.058),but there was a significant correlation between LSM,FBG,AFP and Child-Pugh grade.FBG decreased gradually with the increase of Child-Pugh grade(P < 0.001).LSM,AFP increased gradually with the increase of Child-Pugh grade(P < 0.001).4.FBG and AFP were positively correlated with BCLC stage(r=0.327,P= 0.001;r=0.200,P =0.038,respectively).With the increase of BCLC stage 0?C,the median level of FBG increased at first and then decreased,and the difference among BCLC groups was statistically significant (P=0.008),while the median level of AFP decreased at first and then increased,but there was no significant difference among BCLC groups(P=0.128).However,there was no correlation between LSM,FAP and BCLC stage(P > 0.05).5.The elevated AFP was significantly correlated with portal vein tumor thrombus(P = 0.028),but there was no correlation between LSM,FAP,FBG and portal vein tumor thrombus.There was a significant positive correlation between FBG and maximum diameter of tumor(r = 0.354,P=0.001),but no correlation was found between LSM,FAP,AFP and maximum diameter of tumor(P > 0.1).6.Under the condition of Child-Pugh grade A,the best cut-off value of AFP in the diagnosis of primary liver cancer in patients with liver cirrhosis was 25.62 ng/ml,the sensitivity was 59.1%,the specificity was 83.7%,and AUC was 0.771.The best cut-off value of FBG was 2.515g/l,sensitivity and specificity were 64.8% and 77.6%,respectively,and AUC was 0.749.The combined diagnostic index of AFP and FBG was established by logistic regression.The sensitivity and specificity of AFP combined with FBG in the diagnosis of liver cancer were 67.0% and 88.8%,respectively,and AUC was 0.829,higher than both of two indicators alone.Under the condition of Child-Pugh grade B,the best cut-off value of AFP in the diagnosis of liver cancer was 112.69ng/ml,the sensitivity was 47.6%,the specificity was 80.0%,and AUC was 0.616.The best cut-off value of FBG was 2.145g/l,the sensitivity and specificity were 76.2% and 76.0%,respectively,and AUC was 0.785.The sensitivity and specificity of AFP combined with FBG were 57.1% and 96.0%, respectively,and AUC was 0.802.The specificity of AFP combined with FBG was significantly higher than that of two separate indicators,and the sensitivity was higher than that of AFP.Conclusion: 1.Male,age ? 50 years old,elevated fibrinogen and AFP ? 200ng/ml are independent risk factors for primary liver cancer,and fat attenuation parameter is its protective factor,and liver stiffness measurement is not an independent factor.2.The elevated AFP is significantly correlated with portal vein tumor thrombus and FBG was positively correlated with the maximum diameter of primary hepatocellular carcinoma.3.AFP combined with FBG can improve the sensitivity and specificity of the diagnosis with liver cancer and reduce the missed diagnosis rate.