Background & Aims: Measurements of α-fetoprotein (AFP) detect hepatocellular carcinoma (HCC) with low levels of sensitivity and specificity and are therefore not recommended for use in liver cancer surveillance. test results). We assessed overall accuracy of these factors in detecting HCC using receiver operator characteristic (ROC) curve analysis and the Delong method. We calculated levels of AFP that detect HCC with the highest levels of sensitivity and specificity in subgroups using ROC analysis. Results: The most common etiologies of cirrhosis hepatitis C computer virus (HCV) contamination (60%) and alcohol induced (22%). Nearly 11% of patients were HIV-positive. Levels of AFP >20 ng/mL detected HCC with 70.1% sensitivity and 89.8% specificity. This AFP level identified patients with HCC with a c-statistic of 0.87 (95% confidence interval 0.85 it was significantly more accurate in HCV-negative patients than HCV-positive patients (c-statistic 0.89 vs 0.83; P=.007). AFP levels ≥59 ng/mL most accurately detected HCC in patients with HCV-associated cirrhosis; levels of AFP ≥11 ng/mL accurately identified HCC JWH 073 in HCV-negative patients. Level of AFP identified early-stage HCC with a c-statistic of 0.62 (95% confidence interval 0.58 and had a significantly higher level of accuracy for HIV-positive patients than HIV-negative patients (c-statistic 0.81 vs 0.59; P<.001). Conclusion: Based on retrospective analysis of data from patients with cirrhosis with or without HCC level of AFP most accurately detects HCC in individuals without HCV illness. It detects HCC with a high level of accuracy in individuals with cirrhosis and HIV illness. Keywords: Biomarkers liver disease fibrosis AIDS Intro Hepatocellular carcinoma (HCC) Mouse monoclonal to CD59(PE). is the fifth most common cause of cancer and the third leading cause of cancer-related death worldwide(1). Within the United States and Europe its incidence is definitely rapidly increasing mainly driven by the current epidemic of hepatitis C disease (HCV) and non-alcoholic fatty liver disease (NAFLD) instances(2). Prognosis for individuals with HCC depends on tumor stage at analysis with curative options only available for individuals diagnosed at an early stage. Monitoring with ultrasound only at six-month intervals is recommended in individuals with cirrhosis to detect HCC at an early stage(3). However ultrasound remains operator dependent with a large space between its effectiveness and its performance in medical practice developing a need for effective complementary biomarkers(4-7). Alpha fetoprotein (AFP) the best-studied serologic test is attractive for surveillance as it is definitely relatively inexpensive and easily obtainable. However the most recent guidelines from your American Association for the Study of Liver Diseases (AASLD) no longer recommend using AFP citing poor level of sensitivity and specificity of AFP for early stage HCC. At a cut-off of 20ng/mL the most commonly used cut-off in medical practice AFP has a level of sensitivity and specificity of approximately 60% and 80% for HCC respectively(8). However most studies possess assumed that AFP performs equally well in all individuals independent JWH 073 of liver disease etiology or severity. AFP has been shown to be elevated in several states of liver injury including acute liver failure suggesting decreased specificity in cases with high cell turnover(9 10 Furthermore JWH 073 the specificity of AFP may JWH 073 vary by patient characteristics such as gender and race(6 10 Many of the prior studies were limited by relatively small sample size isolation to only patients with HCV or HBV infection and the inclusion of patients without cirrhosis(10 13 14 However the majority of HCC patients in the United States and Europe have underlying cirrhosis at the time of diagnosis(2 15 and the inclusion of patients with milder degrees of liver disease who carry a low JWH 073 risk of HCC may have unfairly biased the results of prior studies against AFP. Therefore the primary aim of our research was to recognize determinants for level of sensitivity specificity and general precision of AFP inside a cohort of individuals with cirrhosis. A second goal of our research was to define fresh potential cut-offs for AFP in the subgroups of individuals in whom precision varies. METHODS Research Population We carried out a retrospective case-control research of cirrhotic individuals with and without HCC at Parkland Memorial Health insurance and.