Clinical characteristics of patients
The basic clinical characteristics of the 377 cases of patients and controls included in this study were: in the control group, 106 males and 44 females, with a mean age of 46.9 (45.1 to 48.6) years; in the patient group, 179 males and 48 females, with a mean age of 56.6 (55.2 to 58.1) years; in the HCC-BT group, 89 cases, 22 females and 67 males, with a mean age of 57.6 (55.1 ~ 60.2) years; in the HCC-AS group, 26 females and 112 males, mean age 56.0 (54.3 ~ 57.7) years; 35 cases of new lesions or recurrence were seen in HCC-AS, including 30 males and 5 females, mean age 54.2 (49.3 ~ 58.0). All age and gender distributions Pa < 0.001 were not statistically significant. Subjects' AFP, AFP-L3%, and DCP clinical test results are shown in Fig. 1, and AFP-L3% in the figure is based on the test results, when the results were less than 5%, they were recorded as 5%.
As seen in Fig. 1, AFP, AFP-L3%, and DCP showed better sensitivity in HCC patients, and the control group showed more consistent results with very few abnormal values, while the case group had obvious multi-peaked abnormal values, not only more abnormal values but also larger differences in abnormal values than the case group. In addition, it is not difficult to find from the results: that the number of abnormal values and peaks in the HCC-AS group were significantly smaller than those in the HCC-BT group.
The median and interquartile values (with a 95% confidence interval) of AFP and DCP for different groups are shown in Table 1. The results showed that the median and quartile values were the highest in the HCC-BT group, and the difference between the HCC-AS group and the CP group was smaller. Compared with AFP, the median and quartiles of DCP were more significantly different from the CP group.
Table 1
The median and quartile values of AFP and DCP
|
Group
|
Median
|
1st quartile
|
3rd quartile
|
Pa
|
AFP
(ng/mL)
|
CP
|
3.22 (2.98, 3.59)
|
2.49 (2.05, 2.68)
|
4.67 (4.09, 5.00)
|
< 0.0001
|
HCC-BT
|
4.14 (3.48, 9.83)
|
2.79 (2.18, 3.03)
|
35.83 (12.97, 147.49)
|
HCC-AS
|
2.99 (2.87, 3.45)
|
2.22 (1.91, 2.45)
|
5.51 (4.09, 9.70)
|
HCC
|
3.42 (3.02, 3.95)
|
2.35 (2.08, 2.57)
|
10.55 (6.66, 14.39)
|
DCP
(ng/mL)
|
CP
|
10.55 (10.02, 11.19)
|
8.29 (7.34, 9.04)
|
15.61 (13.45, 17.83)
|
HCC-BT
|
25.71 (16.38, 39.59)
|
11.74 (8.73, 14.57)
|
317.05 (57.67, 807.04)
|
HCC-AS
|
11.52 (9.62, 13.22)
|
6.48 (4.10, 8.11)
|
17.83 (15.68, 24.17)
|
HCC
|
13.96 (12.10, 15.82)
|
8.10 (6.40, 9.38)
|
31.68 (24.19, 45.22)
|
Comparison of the diagnostic value of AFP, AFP-L3%, and DCP in the diagnosis and treatment of HCC
ROC analysis showed that the AUCs of AFP, AFP-L3% and DCP in the diagnosis of HCC were 0.564 (95% confidence interval [CI] = 0.513 to 0.615), 0.579 (95% confidence interval [CI] = 0.528 to 0.630) and 0.599 (95% confidence interval [CI] = 0.548 to 0.649) (Fig. 2a), which shows that the variability of each single index for the diagnosis of HCC is not significant and the sensitivity of the actual diagnosis is not high. the AUCs for the combination of DCP and AFP, or DCP and AFP or AFP-L3%, were 0.635 (95% confidence interval [CI] = 0.585 to 0.684), 0.637 (95% confidence interval [CI] = 0.586 to 0.685) (Fig. 2b). It can be seen that the combination of multiple indicators can further improve the diagnosis, but the improvement was not significant, and there was no significant difference in the diagnosis of HCC by DCP combined with AFP, DCP combined with AFP, and AFP-L3%.
Comparison of the diagnostic value of AFP, AFP-L3%, and DCP in the diagnosis and treatment of HCC-BT
From the results of ROC curve analysis, the AUCs of AFP, AFP-L3% and DCP in single-indicator diagnosis were 0.659 (95% confidence interval [CI] = 0.595 to 0.719), 0.640 (95% confidence interval [CI] = 0.576 to 0.701) and 0.740 (95% confidence interval [CI] = 0.679 to 0.794) as in Fig. 3a, comparing the previous diagnostic value in HCC, it is clear that each index is better in HCC-BT, with a general improvement of about 20% in AUC. The AUC was further improved to 0.779 (95% confidence interval [CI] = 0.721 to 0.830) when DCP combined with AFP or the combination of all three tests was used as shown in Fig. 3b.
Comparison of the diagnostic value of AFP, AFP-L3%, and DCP in the diagnosis and treatment of HCC-AS
From the results of the ROC curve analysis, the diagnostic value of AFP, AFP-L3%, and DCP in the single index diagnosis of HCC-AS was low, and their corresponding AUCs were only 0.503, 0.540, and 0.508, respectively (Fig. 4a), and even when DCP was used in combination with AFP or AFP-L3%, the corresponding AUCs were only 0.543, 0.545 (Fig. 4b). 0.545 (as in Fig. 4b).
The comparison of the above results shows that in Fig. 1, AFP, AFP-L3%, and DCP do not have many abnormal values in subjects with HCC-AS, which is consistent with the AUC results reflected by the ROC curve in Fig. 4, while DCP, AFP, AFP-L3% and their combined tests have high diagnostic value in the diagnosis of HCC-BT. It indicates that for HCC-AS, either DCP, AFP, AFP-L3% or their combinations have no diagnostic value, therefore, if HCC-AS is considered as HCC patients, it will lead to a decrease in the diagnostic value of DCP and AFP.