The Clinical Application Study Of Combined Detection Of AFP And TAP In Hepatocellular Carcinoma

Background and purposeHepatocellular carcinoma(HCC)is one of the most common cancers in the world.According to global cancer statistics in 2018,there are approximately 841,000 new cases of HCC worldwide each year,and the mortality rate is high.It is the cause of cancer deaths worldwide.Ranked fourth in the world(the top three are lung cancer,colorectal cancer and gastric cancer).HCC patients generally have no obvious clinical symptoms in the early stage,2/3 of the cases are already in the middle and late stages at the time of diagnosis,and only about 20%of the patients are suitable for surgical treatment.Although surgical resection,liver transplantation,intervention,and targeting can be used to effectively treat HCC,the 5-year overall survival rate is still less than 10%in advanced patients.The 5-year survival rate of HCC patients diagnosed early and given appropriate treatment exceeds 50%,suggesting that early screening can effectively reduce the mortality of HCC patients.Serum tumor markers are necessary non-invasive tools for screening and diagnosing various types of tumors.Many serum tumor markers have been studied and approved for clinical use.For example,Alpha-fetoprotein(AFP)is often used in the diagnosis,efficacy monitoring,and prognosis evaluation of HCC.However,AFP is still insufficient as a diagnostic indicator of liver cancer.Among newly diagnosed HCC patients,only about 60%Of patients have elevated serum AFP levels.In reproductive embryonic tumors,liver cirrhosis,acute severe hepatitis and other diseases,AFP will also increase.Therefore,AFP as a diagnostic indicator of HCC still has the problem of poor specificity and sensitivity.Therefore,it is necessary to combine multiple tumor markers to improve the accuracy of HCC diagnosis.Tumor abnormal protein(TAP)is an abnormal glycoprotein and calcium-histone complex secreted during the metabolism of tumor cells.It has been used for diagnostic screening and efficacy evaluation in a variety of tumors.This study aims to explore the clinical value of combined detection of serum tumor markers AFP and TAP in the diagnosis and prognosis of HCC.MethodsCollected 70 patients with HCC(HCC group),70 patients with liver cirrhosis(cirrhosis group)and 70 patients with chronic hepatitis B(chronic hepatitis)admitted to the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2019.The latter two groups were used as control groups.The AFP and TAP indicators of the three groups of patients were detected,and the Medcalc software was used to draw the receiver operator characteristic curve(ROC)for single and combined testing,and to evaluate the diagnostic efficacy.The Kaplan-Meier method and log-rank test were used for survival analysis,and the Cox regression model was used for prognostic factors.The difference was statistically significant with P<0.05.Results1.Serum TAP and AFP levels in the HCC group were significantly higher than the other two groups,the difference was statistically significant(P<0.05).Compared with the chronic hepatitis B group,there was no statistically significant difference in TAP levels between the liver cirrhosis group and the chronic hepatitis B group(P>0.05),while the difference in AFP levels between the two groups was statistically significant(P<0.05).2.The specificity of TAP alone in the diagnosis of HCC was higher than that of AFP,but there was no significant difference in sensitivity(P>0.05);the specificity of combined diagnosis of HCC was higher than that of AFP and TAP alone,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the sensitivity of the combined diagnosis compared with the single detection of the two indicators(P>0.05).3.The area under the ROC curve of AFP,TAP,and AFP combined with TAP for the diagnosis of HCC were 0.772(95%CIO.709-0.827),0.848(95%CI0.792-0.893)and 0.893(95%CIO.843-0.932),respectively.The area under the curve(AUC)of the combined detection of TAP and AFP in the diagnosis of HCC was greater than that of TAP or AFP alone,and the difference was statistically significant(P<0.05).4.Taking the non-liver cancer group(cirrhosis group and chronic hepatitis B group)as the control group(140 cases),and the AFP-negative liver cancer patients as the case group(35 cases),the ROC curve results showed that the area under the ROC curve for the diagnosis of HCC by TAP was 0.842(95%Cl 0.779-0.893).When the cut-off value of TAP is 115.72μm2,the sensitivity and specificity are 82.9%and 77.9%,respectively.5.Univariate survival analysis showed that serum TAP level,serum AFP level,tumor size,Child-Pugh grade pair are related to patients with DFS(Disease-free survival).Patients with normal TAP and AFP levels,tumors less than 5 cm,and Child-Pugh grade A/B have a better prognosis,and gender and age have nothing to do with the patient’s prognosis.Multivariate analysis of the Cox proportional hazards regression model found that serum TAP level,tumor size,and Child-Pugh classification were independent influencing factors of DFS in HCC patients.Conclusions1.The combined detection of AFP and TAP has good diagnostic efficiency for HCC.2.For AFP-negative HCC patients,TAP still has important diagnostic value..3.TAP combined with AFP to detect HCC can improve the specificity of diagnosis without reducing the sensitivity of diagnosis.4.Serum TAP level,serum AFP level,tumor size,and Child-Pugh classification are related to the prognosis of patients.Among them,serum TAP level,tumor size,and Child-Pugh classification are independent influencing factors of DFS in HCC patients.