Application Value Of Combined Detection Of AFP,CA19-9,FER And PIVKA-? In The Differential Diagnosis Of Benign And Malignant Liver Diseases

Objective:To screen the best combination of tumor markers for differential diagnosis of primary hepatic carcinoma?PHC?and benign liver disease,to evaluate the value of combined tumor markers detection in the differential diagnosis of PHC and benign liver disease,and to investigate the advantages of the combination of tumor markers in clinical staging,tumor metastasis and pathological classification of PHC.Methods:629 PHC patients and 919 benign liver disease patients?including chronic liver disease,liver cirrhosis,hepatic hemangioma,hepatic abscess,hepatic cyst?were enrolled in this retrospective study.The expression levels of the tumor markers in these two groups were statistically analyzed.The best combination of tumor markers used for differential diagnosis of PHC and benign liver disease was screened out by Logistic regression analysis.The differences in diagnostic efficacy of single and combined detection of tumor markers in differential diagnosis of PHC and benign liver disease were evaluated by making ROC curve and comparing the area under the curve.The application values of combined detection of tumor markers in PHC clinical stage,tumor metastasis,pathological type differentiation and monitoring postoperative recurrence were also evaluated by making ROC curve and comparing the area under the curve.Results:1.AFP is the most effective tumor marker in differential diagnosis of PHC and benign liver disease among 12 serum tumor markers?AUCAFP=0.803?.Four tumor markers?AFP,CA19-9,FER and NSE?were screened out from 12 tumor markers for differential diagnosis of PHC and benign liver disease.The most effective combination of tumor markers used in differential diagnosis of PHC and benign liver disease was AFP+CA19-9+FER?AUC=0.815?.The differential diagnostic efficacy of AFP+CA19-9+FER was significantly higher than that of AFP?p=0.0409?.2.The differential diagnostic efficacy of AFP+CA19-9+FER was higher than that of AFP?p=0.0021?in the PHC patients without tumor metastasis,and it was also higher than that of AFP in the early stage of PHC?p=0.00214?.The differential diagnostic efficacy of AFP+CA19-9+FER was similar to that of AFP in patients with advanced metastatic of PHC.The diagnostic efficacy of AFP+CA19-9+FER in differential diagnosis of different pathological types of PHC and benign liver disease was different.The differential diagnostic efficacy of AFP+CA19-9+FER was significantly higher than that of AFP in patients with hepatocellular carcinoma?HCC??p=0.0002?.The differential diagnostic efficacy of AFP+CA19-9+FER?AUC=0.841?was high in patients with mixed cell carcinoma of liver?HCC-ICC?,but it was similar to that of AFP.The differential diagnostic efficacy of AFP+CA19-9+FER?AUC<0.7?was not good in patients with intrahepatic cholangiocarcinoma?ICC?,the same as that of AFP.The combined detection of AFP+CA19-9+FER can make up for the deficiency of AFP in monitoring postoperative recurrence of PHC.3.The diagnostic efficacy of AFP+CA19-9+FER was significantly higher than that of AFP?p=0.0238?in differential diagnosis of PHC and benign liver disease in the patients with positive HBV.However,there was not significantly different between the combined detection of AFP+CA19-9+FER and single detection of AFP in the differential diagnosis of PHC and benign liver disease in the patients with negative HBV?p>0.05?.4.The diagnostic efficacy of combined detection of AFP+CA19-9+FER was not good for differential diagnosis of PHC and benign liver disease in patients with negative AFP?AUC=0.639?.5.The sensitivity and specificity of PIVKA-II in the differential diagnosis of PHC and benign liver disease were 77.8%and 91.3%,respectively,AUC_PIVKA-IIIVKA-II was 0.877.The AUC of AFP+CA19-9+FER+PIVKA-II in the differential diagnosis of PHC and benign liver disease was 0.916,which was significantly higher than that of AFP+CA19-9+FER?p=0.0031?and PIVKA-II?p=0.0264?.6.The AUC of PIVKA-II was 0.834 in the differential diagnosis of PHC and benign liver disease in the patients with negative AFP.The sensitivity and specificity of AFP+CA19-9+FER+PIVKA-II were 94.1%and 74.1%respectively in the differential diagnosis of PHC and benign liver disease in the patients with nagative AFP.The AUC of AFP+CA19-9+FER+PIVKA-II was 0.917 in the differential diagnosis of PHC and benign liver disease in the patients with nagative AFP,which was significantly higher than that of AFP+CA19-9+FER?p=0.0033?and PIVKA-II?p=0.0476?.Conclusion:1.The diagnostic efficacy of AFP+CA19-9+FER in the differential diagnosis of PHC and benign liver disease is higher than that of AFP.The combined detection of AFP+CA19-9+FER plays an auxiliary role in the differentiation of PHC metastasis,staging and pathological classification.The combined detection of AFP+CA19-9+FER can make up for the deficiency of AFP in monitoring postoperative recurrence of PHC.It is also helpful to improve the diagnosis efficacy of differential diagnosis of PHC and benign liver disease in HBV postive patients.2.The combined detection of AFP+CA19-9+FER+PIVKA-II can further improve the differential diagnostic efficacy of PHC and benign liver diseases,especially improve the differential diagnostic efficacy of PHC and benign liver diseases in the patients with negative AFP.