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Optimizing Surveillance Performance of Alpha-Fetoprotein by Selection of Proper Target Population in Chronic Hepatitis B

Author

Listed:
  • Jung Wha Chung
  • Beom Hee Kim
  • Chung Seop Lee
  • Gi Hyun Kim
  • Hyung Rae Sohn
  • Bo Young Min
  • Joon Chang Song
  • Hyun Kyung Park
  • Eun Sun Jang
  • Hyuk Yoon
  • Jaihwan Kim
  • Cheol Min Shin
  • Young Soo Park
  • Jin-Hyeok Hwang
  • Sook-Hyang Jeong
  • Nayoung Kim
  • Dong Ho Lee
  • Jaebong Lee
  • Soyeon Ahn
  • Jin-Wook Kim

Abstract

Although alpha-fetoprotein (AFP) is the most widely used biomarker in hepatocellular carcinoma (HCC) surveillance, disease activity may also increase AFP levels in chronic hepatitis B (CHB). Since nucleos(t)ide analog (NA) therapy may reduce not only HBV viral loads and transaminase levels but also the falsely elevated AFP levels in CHB, we tried to determine whether exposure to NA therapy influences AFP performance and whether selective application can optimize the performance of AFP testing in CHB during HCC surveillance. A retrospective cohort of 6,453 CHB patients who received HCC surveillance was constructed from the electronic clinical data warehouse. Covariates of AFP elevation were determined from 53,137 AFP measurements, and covariate-specific receiver operating characteristics regression analysis revealed that albumin levels and exposure to NA therapy were independent determinants of AFP performance. C statistics were largest in patients with albumin levels ≥ 3.7 g/dL who were followed without NA therapy during study period, whereas AFP performance was poorest when tested in patients with NA therapy during study and albumin levels were

Suggested Citation

  • Jung Wha Chung & Beom Hee Kim & Chung Seop Lee & Gi Hyun Kim & Hyung Rae Sohn & Bo Young Min & Joon Chang Song & Hyun Kyung Park & Eun Sun Jang & Hyuk Yoon & Jaihwan Kim & Cheol Min Shin & Young Soo P, 2016. "Optimizing Surveillance Performance of Alpha-Fetoprotein by Selection of Proper Target Population in Chronic Hepatitis B," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-13, December.
    • Handle: RePEc:plo:pone00:0168189
    DOI: 10.1371/journal.pone.0168189
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    References listed on IDEAS

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    1. Margaret S. Pepe & Gary Longton & Holly Janes, 2009. "Estimation and comparison of receiver operating characteristic curves," Stata Journal, StataCorp LP, vol. 9(1), pages 1-16, March.
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    1. Chung Seop Lee & Yong Jin Jung & Soon Sun Kim & Jae Youn Cheong & Ga Ram Lee & Han Gyeol Kim & Beom Hee Kim & Jung Wha Chung & Eun Sun Jang & Sook-Hyang Jeong & Kyung Ho Lee & Jin-Wook Kim, 2018. "Liver volume-based prediction model stratifies risks for hepatocellular carcinoma in chronic hepatitis B patients on surveillance," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.

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