Laboratory test markers for liver cancer

Epidemiology of liver cancer

Primary liver cancer (PLC) is the fifth most common malignant tumor in the world, and the third highest fatality rate in cancer patients

The incidence of liver cancer in China is about 12.

Two-thirds of liver cancers are found in the middle and late stages, the 1-year survival rate is only 30%-40%, and the 5-year survival rate is only about 14.

The low 5-year survival rate of liver cancer is mainly due to the low rate of early diagnosis, which is the key to reducing the mortality rate

Serum markers are the most convenient and non-invasive diagnostic methods in clinical application

alpha-fetoprotein

Serum alpha-fetoprotein (AFP) is the most widely used serological indicator

In recent years, the European Society for the Study of the Liver and the American Society for the Study of Liver Disease no longer use AFP as a screening and diagnostic standard for liver cancer in their updated diagnosis and treatment guidelines

abnormal prothrombin

Abnormal prothrombin (DCP/PIVKA-II) is a vitamin K deficiency or antagonist-II-induced protein, also known as PIVKA-II

Clinical research findings

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Alpha-fetoprotein heterogenous ratio

The clinically detected AFP is actually the total AFP protein, including AFP-L1, AFP-L2, and AFP-L3

The study found that the increase of AFP-L3% appeared 3 to 28 months earlier than the positive imaging examination, and the positive rate of AFP-L3% in predicting the occurrence of liver cancer was 94%

In addition, for AFP-negative HCC patients, AFP-L3% also has a certain detection rate, which can reduce the missed detection of AFP-negative HCC

The value of triple examination for liver cancer in the diagnosis of liver cancer

Currently, the triple detection of liver cancer is a combination of serum markers commonly used in the early diagnosis of liver cancer

In the prognostic assessment of liver cancer, the more AFP, AFP-L3% and DCP positive numbers, the lower the postoperative survival rate and the higher the recurrence rate.

DCP and AFP-L3% have no correlation with AFP serum levels and are independent markers; DCP and AFP-L3% are very valuable markers for the management of liver cancer; DCP and AFP-L3% are related to tumor size and tumor size The stage is positively correlated, so the triple examination of liver cancer is helpful for the differential diagnosis of intrahepatic nodules
.

Recommended domestic and foreign guides

Among the serum markers for the diagnosis of liver cancer, AFP, AFP-L3%, and DCP have been written into the guidelines by the Asia-Pacific Society of Liver Diseases and the Japanese Society of Liver Diseases, which are recommended for screening of high-risk groups, auxiliary diagnosis of liver cancer, Monitoring treatment effects as a prognostic and relapse prediction tool
.

In China's "Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2015 Edition)" and "Primary Liver Cancer Diagnosis and Treatment Standards (2017 Edition)", AFP, AFP-L3%, and DCP are also recommended as important indicators for the diagnosis of HCC, which can be mutually used with AFP.
supplement and can improve the early diagnosis rate of HCC
.

Authoritative guidelines and consensuses such as Parameter, APASL, and JSH all recommend DCP, AFP, and AFP-L3% as specific serum markers for HCC screening and diagnosis
.

In conclusion, at the current stage of primary liver cancer in China, chronic HBV infection is still the main pathogenic factor, AFP still has good application value in the diagnosis and prognosis evaluation of liver cancer, and DCP and AFP-L3 are used as the diagnosis of liver cancer.
A classic serological indicator that has a complementary relationship with AFP
.