Published online Sep 28, 2019. doi: 10.3748/wjg.v25.i36.5515
Peer-review started: July 25, 2019
First decision: August 17, 2019
Revised: August 25, 2019
Accepted: September 9, 2019
Article in press: September 9, 2019
Published online: September 28, 2019
Protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP) are widely used biomarkers in the diagnosis of hepatocellular carcinoma (HCC), and have been written into the guidelines for HCC diagnosis published by the National Society of Hepatology of different countries. However, PIVKA-II and AFP have unsatisfactory specificity and sensitivity in the diagnosis of hepatitis B virus (HBV)-related HCC, especially in early-stage HBV-related HCC.
Researchers have evaluated the diagnostic value of biomarkers in HCC. However, it is difficult to obtain ideal biomarkers for early-stage HCC, even if combined detection of existing biomarkers. This study evaluated the diagnostic value of the ratio of gamma-glutamyltransferase to aspartate aminotransferase (γ-GT/AST ratio) in different classifications of HBV-related HCC, which can effectively improve the diagnostic efficiency for HBV-related HCC.
The objective of this study was to evaluate the diagnostic value of the γ-GT/AST ratio, PIVKA-II, and AFP, alone or in combination, in different categories of HBV-related HCC.
We retrospectively analyzed the clinical and laboratory data of HBV-related HCC and chronic hepatitis B (CHB) patients, and classified those data according to the tumour size and serum level of HBV DNA. The diagnostic value of the γ-GT/AST ratio, PIVKA-II, and AFP in different categories of HBV-related HCC was evaluated comprehensively and systematically.
Tumour size was positively correlated with serum levels of PIVKA-II and AFP in HCC patients, but there was no correlation between tumour size and the γ-GT/AST ratio. The areas under receiver-operating characteristic curves (AUROCs) of the γ-GT/AST ratio were not significantly different between early-stage HBV-related HCC patients and HBV-related HCC patients. When PIVKA-II and AFP were combined with the γ-GT/AST ratio in the diagnosis of HBV-related HCC patients, early-stage HBV-related HCC patients, HBV DNA+ HCC patients, and HBV DNA- HCC patients, the AUROCs of those biomarkers were increased.
The γ-GT/AST ratio is a useful biomarker for the diagnosis of HBV-related HCC and may be more useful than PIVKA-II and AFP in the diagnosis of early-stage HBV-related HCC. The combination of PIVKA-II and AFP with the γ-GT/AST ratio can enhance the diagnostic value of these biomarkers in different categories of HBV-related HCC.
This study assessed the diagnostic value of the γ-GT/AST ratio, PIVKA-II, and AFP in different categories of HBV-related HCC. According to the correlation between tumour size of HBV-related HCC patients and the γ-GT/AST ratio, we inferred that the γ-GT/AST ratio may be more useful than PIVKA-II and AFP in the diagnosis of early-stage HCC. This hypothesis should be validated in future studies.