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Hepatology International

, Volume 2, Issue 1, pp 17–30 | Cite as

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

  • Ryosuke Tateishi
  • Haruhiko Yoshida
  • Yutaka Matsuyama
  • Norio Mine
  • Yuji Kondo
  • Masao Omata
ORIGINAL ARTICLE

Abstract

Background and aims The role of alphafetoprotein (AFP) in the diagnosis and surveillance of hepatocellular carcinoma (HCC) is getting smaller owing to the advances in imaging modalities. The aims of this study were to assess the diagnostic accuracy of tumor markers in small HCC and to find the optimal cutoff value of each tumor marker for efficient surveillance. Methods Studies in all languages were identified by searching MEDLINE from 1982 to 2002. Studies were included when they showed sensitivity and specificity for HCCs 5 cm or smaller and recruited only patients with chronic hepatitis or liver cirrhosis as control. We assessed diagnostic odds ratios (DORs) for the evaluation of diagnostic accuracy of tumor markers and positive likelihood ratios (LRs+) to find the optimal cutoff value. DORs and LRs+ were combined according to the random effect model. The summary receiver operating characteristics (ROC) curve was also assessed. Results Seventeen articles on three tumor markers—AFP, des-gamma-carboxyprothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)—were enrolled after full-text evaluation. AFP was inferior to DCP and AFP-L3 in both DOR (4.50 vs. 8.16 and 10.50) and area under the ROC curve (0.647 vs. 0.688 and 0.695). Optimal cutoff values that provide the best LR+ were 200 ng/ml for AFP, 40 mAU/ml for DCP, and 15% for AFP-L3. Conclusions Diagnostic accuracy of AFP in small HCC was substantially limited. Surveillance including other tumor markers with optimal cutoff value should be conducted to confirm the efficacy of the policy.

Keywords

Hepatocellular carcinoma Alphafetoprotein Des-gamma-carboxyprothrombin Lens culinaris agglutinin-reactive fraction of alphafetoprotein Metaanalysis 

Abbreviations

AFP

Alphafetoprotein

AFP-L3

Lens culinaris agglutinin-reactive fraction of AFP

AUC

Area under the curve

CI

Confidence interval

DCP

Des-gamma-carboxyprothrombin

DOR

Diagnostic odds ratio

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

LR+

Positive likelihood ratio

ROC

Receiver operating characteristics

SE

Standard error

Notes

Acknowledgment

The authors thank Hiromichi Suzuki and Ayami Nishioka at the International Medical Information Center for technical support in article searching and managing the reference database.

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Copyright information

© Asian Pacific Association for the Study of the Liver 2007

Authors and Affiliations

  • Ryosuke Tateishi
    • 1
  • Haruhiko Yoshida
    • 1
  • Yutaka Matsuyama
    • 2
  • Norio Mine
    • 1
  • Yuji Kondo
    • 1
  • Masao Omata
    • 1
  1. 1.Department of Gastroenterology, Graduate School of MedicineUniversity of TokyoTokyoJapan
  2. 2.Department of Biostatistics, Graduate School of MedicineUniversity of TokyoTokyoJapan

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