TITLE:
The Combined Diagnostic Accuracy of Serum Alpha Fetoprotein and Des-Gamma Carboxyprothrombin in Hepatocellular Carcinoma among Chronic Liver Disease Patients in Ilorin
AUTHORS:
A. M. Aliyu, A. B. Olokoba, M. O. Bojuwoye, K. C. Okonkwo
KEYWORDS:
Necro-Inflammation, Liver Cirrhosis, Hepatocellular Carcinoma, Alpha Fetoprotein, Des-Gamma-Carboxyprothrombin, Enzyme-Linked Immunoassay, Percutaneous, Tumor Markers
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.11 No.12,
December
22,
2021
ABSTRACT: Introduction :Chronic liver disease (CLD) is a disease of public
health importance. CLD is defined as a clinical syndrome of liver
disease lasting for at least six months with histology showing varying degree
of hepatocellular necro-inflammation and fibrosis with or without neoplastic
transformation. The disease is a spectrum that manifests initially as chronic
hepatitis which may progress to liver cirrhosis and ultimately hepatocellular
carcinoma (HCC). The current practice in the field of Gastroenterology has shifted from
invasive methods of diagnosing HCC to non-invasive methods using tumor
biomarkers. Various biomarkers of HCC have been proposed, but the largest body
of evidence exists with alpha-fetoprotein (AFP). Most of
the studies on the combined diagnostic accuracy of AFP and des-gamma-carboxyprothrombin
(DCP) were done in other populations outside Nigeria. It is necessary to
determine the combined diagnostic accuracy of the two tumor markers for early detection
of HCC in North-central Nigeria. Materials and Methods: This study was a cross-sectional study and ethical
clearance was obtained from the ethical and research committee of UITH,
Ilorin. A total of 190 participants consisting of 125 cases and 65 healthy
controls that were age and sex-matched were studied. Patients with extra-hepatic
malignancies were excluded. The serum levels of AFP and DCP were determined
using the enzyme-linked immunoassay (ELISA) technique. A detailed questionnaire
was used to document the socio-demographic characteristics, clinical features
as well as results of laboratory/radiologic parameters. Percutaneous liver
biopsy was carried out on patients that were fit. Test of association between
categorical variables was carried out using the Chi-Square Test. The
sensitivity, specificity, positive and negative predictive values of the two
tumor markers were determined by the area under curve (AUC) at various cut-off
levels using the receiver operating characteristic (ROC) curve analysis.
Statistical significance was set at p value EiTest MONO P-II kit) were used to assay AFP and DCP
respectively. Liver biopsy needle (Menghini needle) was used to carry out liver
biopsy. Results: Using a cut-off of 400 ng/ml,
the sensitivity of serum AFP for diagnosing HCC was 51.3%. The specificity of
AFP at the same cut-off was 87.8%. The positive and negative predictive values
were 92.8% and 49.3% respectively. Using a cut-off of 7.5 ng/ml,
the sensitivity of serum DCP for diagnosing HCC was 57.1%. The specificity of
DCP at the same cut-off was 63.4%. The positive and negative predictive values
were 76.2% and 41.9% respectively while the accuracy was 59.2%. The
diagnostic accuracy of combined serum AFP and DCP for diagnosis of HCC in
University of Ilorin Teaching Hospital, Ilorin was 64.9%. The sensitivity of
combined serum AFP and DCP for diagnosing HCC was 55.6%. The specificity of
combined serum AFP and DCP was 95.6%. The positive and negative predictive
values were 96.2% and 52.3% respectively. Conclusion: Combining these two tumour markers does not
significantly improve the diagnostic accuracy of HCC and chronic HBV remains a
strong aetiological agent of HCC in UITH, Ilorin.