| Objective To evaluate the clinical application value of serum highly sensitivity Lens culinaris agglutinin-reactive alpha-fetoprotein ratio(hs-AFP-L3%)in the diagnosis and treatment of hepatocellular carcinoma(HCC).Methods The serum levels of hs-AFP-L3%and alpha-fetoprotein(AFP)were measured by microchip capillary electrophoresis and liquid-phase binding assay in 160patients with HCC,32 patients with intrahepatic cholangiocarcinoma(ICC),52 patients with post-hepatitis B liver cirrhosis,53 patients with chronic hepatitis B and 50 healthy controls who were enrolled at the Affiliated Hospital of Qingdao University,from October 2016 to March 2018.The clinical application value of hs-AFP-L3%was estimated in HCC,especially in HCC patients with AFP-negative(AFP<20 ng/mL).The serum levels of hs-AFP-L3%and AFP shew skewed distribution.so the results of the two indicators in patients were expressed by media and quartiles.The non-paramertric Kruskal-Wallis H test was done for comparison between all groups.The Mann-Whitney U test was used for comparion between the two groups.The area under the receiver operating characteristic curve(ROC-AUC)was compared by the z-score test.The sensitivity and specificity were compared by chi-square test.The correlation between the serum levels of the two markers and tumor size and clinical stage of HCC were analyzed by Spearman correlation analysis.The serum level changes of the two indicators in HCC patients before and after treatment were compared by Wilcoxon signed rank test.Results(1)The serum levels of hs-AFP-L3%and AFP in HCC group were obviously higher than that in ICC,cirrhosis,chronic hepatitis and healthy controls groups(hs-AFP-L3%:U=461.00,1485.50,1141.00,625.00,AFP:U=401.50,2207.00,1254.00,266.00,all P<0.001),and the positive rates of the two markers in HCC group also were higher than that in ICC,cirrhosis,chronic hepatitis and healthy controls groups(hs-AFP-L3%:?~2=47.33,50.46,69.90,66.89,AFP:?~2=53.76,14.72,36.71,75.00,all P<0.001).(2)There was no significant difference in ROC-AUC between hs-AFP-L3%,AFP and hs-AFP-L3%+AFP in the diagnosis of HCC(Z=1.47,1.74,0.60,P>0.05).The sensitivity of hs-AFP-L3%(66.3%)for HCC did not differ from AFP(70.0%)(?~2=0.54,P>0.05).The sensitivity of the two markers combined for HCC was 82.5%,which were higher than that of any one marker individually(?~2=24.04,18.05,all P<0.01).The specificity of hs-AFP-L3%for HCC was 95.2%,which was higher than that of AFP(68.6%)(?~2=26.04,P<0.01).The specificity of the combination of two markers was68.6%,which was lower than that of hs-AFP-L3%alone(95.2%)(?~2=26.04,P<0.01).The specificity of hs-AFP-L3%combined by AFP was not decreased compared to AFP(68.6%)(P>0.05).(3)The sensitivity of hs-AFP-L3%in AFP-negative(AFP<20ng/mL)patients with HCC was 41.7%.(4)The serum levels of hs-AFP-L3%and AFP were positively correlated with tumor size and stage separately(hs-AFP-L3%:r=0.272,0.436,AFP:r=0.375,0.458,all P<0.001).(5)Operation treatment could apparently decreased the serum hs-AFP-L3%and AFP levels(Z=-5.37,-4.82,all P<0.001),with the higher hs-AFP-L3%reduction compared to AFP(U=532.5,P<0.05)in 38 patients with HCC.(6)There was no correlation between hs-AFP-L3%and serum AFP levels(r=0.077,P>0.05).Conclusion(1)The sensitivity of hs-AFP-L3%for HCC is similar to that of AFP,while the specificity is superior to that of AFP.The combination of hs-AFP-L3%and AFP can significantly increase the sensitivity for HCC.(2)The serum hs-AFP-L3%has a high diagnostic value in alpha-fetoprotein-negative HCC.(3)The serum hs-AFP-L3%can be used as an auxiliary marker for monitoring the curative effect of HCC,and it can reflect the postoperative curative effect more accurately than AFP. |
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