| ObjectiveHepatocellular carcinoma(HCC)accounts for 70% ～ 85% of all primary liver cancers and is one of the important causes of death in patients with end-stage liver disease.Epidemiological surveys have shown that the 5-year survival rate of primary liver cancer is 15%.The high mortality rate is mainly due to the late diagnosis period and high recurrence rate after curative treatment.Therefore,screening of people at high risk of HCC as well as monitoring of treatment outcomes have become important measures to reduce their mortality.Serological AFP is currently an important method for early diagnosis of HCC.However,the sensitivity of AFP is low to meet for early diagnosis of HCC.In recent years,the clinical application of novel serum markers such as HSP90,AFP-L3 and GP73 has led to further progress in the early diagnosis of hepatocellular carcinoma.In this study,we investigated the value of HSP90,AFP-L3,GP73 combined with AFP in the early diagnosis of HCC,and used serum tumor markers to establish an early diagnosis model of HCC,providing some clinical value for the early diagnosis of HCC.MethodsA retrospective cohort study was conducted to collect a total of 845 hospitalized patients and healthy subjects in the physical examination center from August 2017 to August 2020 in Shaanxi Provincial People’s Hospital,including 407 patients with hepatocellular carcinoma,282 patients with liver cirrhosis,and 156 healthy controls(all HBVHCV negative in healthy subjects).The clinical data of the included population were recorded,and the serum AFP,AFP-L3,GP73 and HSP90 levels were measured,respectively.Based on Graph Pad Prism7 and SPSS 22.0 software,the group measurement data were expressed as mean ± SD.Receiver operating characteristic curve(ROC)was established to calculate the sensitivity and specificity of each serum marker in the diagnosis of hepatocellular carcinoma,evaluate the diagnostic value of serum markers,and compare the diagnostic value of new tumor markers by combining the two serum markers.GALHS(GP73,AFP,AFP-L3,HSP90,Sex)was established by regression analysis,and the sensitivity,specificity,accuracy,area under ROC curve and other indicators were calculated to evaluate the diagnostic value for HCC and achieve early diagnosis of HCC;Results1.Tumor markers serum AFP,AFP-L3,serum HSP90 and GP73 were significantly different between HCC group and non-HCC group(P < 0.05)2.The sensitivity of AFP,AFP-L3,HSP90 and GP73 for the diagnosis of HCC was61.5%,79.7%,82.5% and 74.6%,the specificity was 86.2%,76.4%,70.4% and 70.5%,and the area under ROC curve was 0.759,0.823,0.799 and 0.801,respectively,and the difference was statistically significant(P < 0.05).3.The combination of tumor markers improves the diagnostic value compared with single detection.The sensitivities of AFP combined with AFP-L3,AFP combined with HSP90,and AFP combined with GP73 were 84.4%,83.2%,and 82.3%,respectively;the specificities were 86.7%,91.2%,and 79.1%,respectively,and the areas under the ROC curves were 0.885,0.876,and 0.856,respectively,and the differences were statistically significant(P < 0.05).4.The novel diagnostic model GALHS(GP73,AFP,AFP-L3,HSP90,Sex)improves the diagnostic value of combined diagnosis of multiple tumor markers,with GALHS sensitivity of 92.4%,specificity of 94.8%,and area under the ROC curve of0.938.Conclusion1.AFP,AFP-L3,HSP90 and GP73 have certain value for the early diagnosis of HCC;2.The combination of the two tumor markers can significantly improve the early diagnostic value of HCC,but the combination of tumor markers does not maximize the diagnostic value;3.Serum AFP,AFP-L3,HSP90 and GP73 are insufficient for the diagnosis of HCC,and the combined diagnosis can make up for the lack of single diagnosis.The use of regression model to establish a new diagnostic scoring formula GALHS can maximize the diagnostic value. |
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