Discussion On The Clinical Application Value Of Alpha-fetoprotein

Background:AFP(alpha-fetoprotein),as a traditional tumor marker,has been the most important tumor marker for the diagnosis of Primary liver cancer since it was discovered in the 1960s.However,with the development of medical imaging technology,its value in clinical application has been less and less valued.The 2017 guidelines for the diagnosis and treatment of primary liver cancer in China recommend AFP ?400?g/L to be the diagnostic standard,but the sensitivity to the diagnosis of liver cancer is low,the rate of missed diagnosis is high,joint imaging and other hematological examination is needed,at present,there is still controversy about the optimal AFP threshold for the diagnosis of HCC at home and abroad.The 2017 guidelines for the diagnosis and treatment of primary liver cancer recommend people at high risk of liver cancer once every 6 months to check B-mode ultrasonography and AFP,the ultrasound suspicious lesions or AFP>200?g/L(or>400?g/L)of the people in the process of liver cancer diagnosis and treatment,and for elevated AFP low concentration(20?200?g/L)or AFP negative(<20?g/L)of the crowd,not enough attention,likely to cause delayed or missed diagnosis of early hepatocellular carcinoma.Object:In order to further explore the clinical application and combined application value of AFP,The study is made in the following aspects:1.To investigate the epidemiological characteristics of AFP in serum of primary hepatocellular carcinoma,including the incidence of male and female,the correlation between serum AFP level and gender and age,and the clinical characteristics of AFP negative primary hepatocellular carcinoma.2.To explore the application value and optimal threshold of AFP in the diagnosis of hepatocellular carcinoma,and hope to provide reference for the development of diagnostic criteria and clinical application of primary liver cancer.3.To explore the value of AFP combined with B ultrasound in early screening and diagnosis of liver cancerMethods:The AFP data of 4210 patients were collected and relevant clinical data were collected,including the patient's name,gender,hospital number,age and AFP value,and the type of diagnosed disease.1.The distribution of AFP among liver cancer patients of different genders and ages was statistically analyzed to analyze whether there was a correlation between the AFP level of liver cancer patients and gender and age.2.The clinical characteristics of AFP negative primary liver cancer patients were analyzed statistically3.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value,and diagnostic odds ratio of AFP in the diagnosis of hepatocellular carcinoma were calculated using the criteria of>400?g/L.AFP measurements in patients with hepatocellular carcinoma,viral hepatitis B were consecutively divided into 10 data segments.Their sensitivity,specificity,positive rate,likelihood ratio,positive likelihood ratio,negative likelihood ratio,and diagnostic odds ratio were calculated respectively.The ROC curve was plotted to determine the optimal diagnostic threshold.4.The statistics of the sensitivity,specificity and diagnostic advantage ratio of B-ultrasound,AFP values and their combination in the diagnosis of liver cancer at the critical value distributions of 20-200 ?g/L,200-400 ?g/L and>400 ?g/L,respectively.Results:1.The differences of primary liver cancer incidence between men and women,more men than women,men and women ratio is 3.4:1(1705:507),primary liver cancer AFP levels in different gender see no statistical differences(z=1.118,p = 0.264),no statistical differences between different age groups(x2 = 7.513,p = 0.111)2.There was no statistical difference between AFP negative patients and AFP positive patients in gender,blood type,family history and drinking history,P>0.05.There was a statistical difference in age between the two groups,P =0.007,in which the average age of the AFP negative group was higher than that of the AFP positive group.In terms of clinical symptoms,complications and examination results,there was no statistical difference in the incidence of jaundice and ascites,and the positive rate of HbsAg between the two groups.P>0.05 showed that the asymptomatic proportion of AFP in the negative group was higher than that in the positive group.The proportion of grade AB patients with child-pugh liver function grading in the AFP negative group was higher than that in the AFP positive group,with statistical difference(P<0.05).The proportion of patients with stage ?a,?b and ?a in the AFP negative group was higher than that in the AFP positive group,while the proportion of patients with stage ?b and IV was lower than that in the AFP positive group,showing statistical difference(P<0.05).There was no statistical difference in the proportion of patients with stage ?b and ?a between the two groups(P>0.05).3.When AFP ?400 ?g/L was used as the standard for diagnosis of liver cancer,the sensitivity of AFP was 31.92%,specificity was 92.01%,accuracy was 70.51%,positive predictive value was 69.46%,and negative predictive value was 88.11%.The ratio is 5.40.The diagnostic advantage was highest(5.46)when AFP cutting value during 200?250?g/L,the sum of sensitivity and specificity is maximum(1.3701),by ROC curve drawing,the area of cutting value of 200?250?g/L under the ROC curve(AUC)maximum(0.8964).The optimal threshold for AFP diagnosis in liver cancer is 200 ?g/L.4.The sensitivity of ultrasound in diagnosis of liver cancer was significantly increased and the specificity decreased.With AFP>20?g/L combined with b-ultrasonography,the sensitivity was 95.35%,and the diagnostic advantage was 26.13,and the diagnostic efficacy was good.Conclusion:1.There was a difference in the incidence of male and female patients with liver cancer,and there were more male patients than women,and there was no correlation between AFP concentration and gender and age in liver cancer patients.2.AFP negative primary hepatocellular carcinoma has its specific clinical characteristics,the specific reasons need further study.3.The sensitivity to diagnosis of liver cancer is low,the diagnosis rate is high,and the optimal threshold for diagnosis of liver cancer is 200pg/L.4.AFP combined with B ultrasound can significantly improve the sensitivity of,diagnosis of liver cancer,reduce the rate of missed diagnosis of liver cancer,and recommend the combination of AFP>20?g/L as the standard for liver cancer screening.