Diagnostic value of serological parameters-based Logistic regression model for hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2022.06.016

Abstract

Abstract:

Objective

To establish a Logistic regression model based on serological parameters for the diagnosis of hepatocellular carcinoma (HCC) and to evaluate its application value.

Methods

A total of 473 patients with liver diseases who were admitted to the Third Affiliated Hospital of Sun Yat-sen University for the first time from January 2017 to December 2019 were recruited, including 231 cases of HCC, 113 cases of hepatitis B cirrhosis and 129 chronic hepatitis B. 111 healthy subjects in the same period were assigned into the control group. The informed consents of all patients were obtained and the local ethical committee approval was received. The diagnostic model for HCC was established by Logistic regression analysis. The efficiency of this model was evaluated by the receiver operating characteristic (ROC) curve.

Results

Multivariate Logistic regression analysis showed that age, sex, AST, total bile acid (TBA) and AFP were significantly correlated with the incidence of HCC (HR=1.07, 0.14, 0.99, 0.99, 1.01; P<0.05). The formula of Logistic regression model: Logit(P)=-1.004+0.065×age-1.971×sex (male=1, female=2)+0.006×AFP-0.014×AST-0.008×TBA. The area under the ROC curve (AUC), sensitivity and negative predictive value of ROC curve of multivariate Logistic regression model based on age, sex, AST, TBA and AFP were the highest up to 0.878, 0.719 and 0.820, respectively. The AUC of this model in diagnosing HCC was significantly higher than 0.762 of the AFP-based model (Z=5.363, P<0.05).

Conclusions

Multivariate Logistic regression model based on age, sex, AST, TBA and AFP contributes to enhancing the diagnostic efficiency of HCC.

Key words: Carcinoma, hepatocellular, Diagnosis, Alpha fetoprotein, Aspartate aminotransferase, Total bile acid

Jiahao Chen, Xiaohong Kuang, Yuan Liao, Zhihuan Liu, Zhongcheng Chen, Wenying Zhou. Diagnostic value of serological parameters-based Logistic regression model for hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(06): 615-618.

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References 20

[1]	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版) [J]. 中华肝脏病杂志, 2022, 30(4):367-388.
[2]	Forner A, Reig M, Bruix J. Hepatocellular carcinoma[J]. Lancet, 2018, 391(10127):1301-1314.
[3]	中华医学会肝病学分会. 原发性肝癌二级预防共识(2021年版)[J]. 中华肝脏病杂志, 2021, 29(3):216-226.
[4]	Luo P, Wu S, Yu Y, et al. Current status and perspective biomarkers in AFP negative HCC: towards screening for and diagnosing hepatocellular carcinoma at an earlier stage[J]. Pathol Oncol Res, 2020, 26(2):599-603.
[5]	谢婵, 高志良. 血液标志物用于临床肝细胞癌早期筛查的专家共识[J]. 中国病毒病杂志, 2021, 11(5):334-340.
[6]	Wang T, Zhang KH. New blood biomarkers for the diagnosis of AFP-negative hepatocellular carcinoma[J]. Front Oncol, 2020(10):1316.
[7]	Xu XF, Liang L, Xing H, et al. Clinical utility of serum biomarkers for hepatocellular carcinoma[J]. Biomark Med, 2021, 15(3):151-155.
[8]	徐小元, 丁惠国, 李文刚, 等. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11):2408-2425.
[9]	中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版) [J]. 中华临床感染病杂志, 2019, 12(6):401-428.
[10]	Luo P, Yin P, Hua R, et al. A Large-scale, multicenter serum metabolite biomarker identification study for the early detection of hepatocellular carcinoma[J]. Hepatology, 2018, 67(2):662-675.
[11]	Liu D, Luo Y, Chen L, et al. Diagnostic value of 5 serum biomarkers for hepatocellular carcinoma with different epidemiological backgrounds: a large-scale, retrospective study[J]. Cancer Biol Med, 2021, 18(1):256-270.
[12]	Debes JD, Romagnoli PA, Prieto J, et al. Serum biomarkers for the prediction of hepatocellular carcinoma[J]. Cancers, 2021, 13(7):1681.
[13]	Qi F, Zhou A, Yan L, et al. The diagnostic value of PIVKA-Ⅱ, AFP, AFP-L3, CEA, and their combinations in primary and metastatic hepatocellular carcinoma[J]. J Clin Lab Anal, 2020, 34(5):e23158.
[14]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
[15]	Liu X, Meng J, Xu H, et al. Alpha-fetoprotein to transaminase ratio is related to higher diagnostic efficacy for hepatocellular carcinoma[J]. Medicine, 2019, 98(17):e15414.
[16]	Ding Y, Liu K, Xu Y, et al. Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV-related hepatocellular carcinoma[J]. Cancer Med, 2020, 9(9):3057-3069.
[17]	李军飞, 畅智慧, 王海瑞, 等. 肝细胞癌患者血清总胆汁酸水平升高的影响因素分析[J]. 现代肿瘤医学, 2017, 25(21):3461-3464.
[18]	Liu M, Wu R, Liu X, et al. Validation of the GALAD model and establishment of GAAP model for diagnosis of hepatocellular carcinoma in Chinese patients[J]. J Hepatocell Carcinoma, 2020(7): 219-232.
[19]	Huang C, Fang M, Xiao X, et al. Validation of the GALAD model for early diagnosis and monitoring of hepatocellular carcinoma in Chinese multicenter study[J]. Liver Int, 2022, 42(1):210-223.
[20]	Feng H, Li B, Li Z, et al. PIVKA-Ⅱ serves as a potential biomarker that complements AFP for the diagnosis of hepatocellular carcinoma[J]. BMC Cancer, 2021, 21(1):401.

指标		肝癌组	肝硬化组	慢乙肝组	正常对照组
年龄(岁，±s)		53±12	53±13	42±12	41±12
性别（男/女，例）		211/20	80/33	105/24	67/44
肝功能指标[M(Q_R)]
	AST(U/L)	34(26)	50(58)	119(299)	22(7)
	ALT(U/L)	35(25)	39(36)	151(593)	21(18)
	GGT(U/L)	61(77)	99(130)	83(144)	26(17)
	AFU(U/L)	38(17)	37(17)	42(28)	32(9)
	TBA(μmol/L)	8.0(15.4)	45.0(90.4)	33.1(162.9)	3.2(3.2)
	AFP(μg/L)	73.6(994.1)	6.6(19.2)	11.7(46.1)	2.8(2.2)
血常规指标[M(Q_R)]
	WBC(×10⁹/L)	5.9(2.8)	4.5(2.6)	5.9(2.2)	6.0(2.1)
	Plt(×10⁹/L)	171(105)	106(96)	175(73)	243(83)

指标		肝癌组	肝硬化组	慢乙肝组	正常对照组
年龄(岁，±s)		53±12	53±13	42±12	41±12
性别（男/女，例）		211/20	80/33	105/24	67/44
肝功能指标[M(Q_R)]
	AST(U/L)	34(26)	50(58)	119(299)	22(7)
	ALT(U/L)	35(25)	39(36)	151(593)	21(18)
	GGT(U/L)	61(77)	99(130)	83(144)	26(17)
	AFU(U/L)	38(17)	37(17)	42(28)	32(9)
	TBA(μmol/L)	8.0(15.4)	45.0(90.4)	33.1(162.9)	3.2(3.2)
	AFP(μg/L)	73.6(994.1)	6.6(19.2)	11.7(46.1)	2.8(2.2)
血常规指标[M(Q_R)]
	WBC(×10⁹/L)	5.9(2.8)	4.5(2.6)	5.9(2.2)	6.0(2.1)
	Plt(×10⁹/L)	171(105)	106(96)	175(73)	243(83)

指标	单因素分析		多因素分析
指标	HR（95%CI）	P值	HR（95%CI）	P值
年龄(岁)	1.05(1.03~1.06)	<0.001	1.07(1.05~1.09)	<0.001
性别	0.24(0.14~0.40)	<0.001	0.14(0.07~0.29)	<0.001
AST(U/L)	0.99(0.99~1.00)	<0.001	0.99(0.98~1.00)	0.001
ALT(U/L)	1.00(0.99~1.00)	<0.001	1.00(0.99~1.00)	0.615
GGT(U/L)	1.00(1.00~1.00)	0.977
AFU(U/L)	1.00(1.00~1.01)	0.875
TBA(μmol/L)	0.99(0.98~0.99)	<0.001	0.99(0.98~1.00)	0.005
AFP (μg/L)	1.00(1.00~1.01)	<0.001	1.01(1.00~1.01)	<0.001
WBC(×10⁹/L)	1.07(1.00~1.14)	0.063
Plt(×10⁹/L)	1.00(1.00~1.00)	0.786

指标	单因素分析		多因素分析
指标	HR（95%CI）	P值	HR（95%CI）	P值
年龄(岁)	1.05(1.03~1.06)	<0.001	1.07(1.05~1.09)	<0.001
性别	0.24(0.14~0.40)	<0.001	0.14(0.07~0.29)	<0.001
AST(U/L)	0.99(0.99~1.00)	<0.001	0.99(0.98~1.00)	0.001
ALT(U/L)	1.00(0.99~1.00)	<0.001	1.00(0.99~1.00)	0.615
GGT(U/L)	1.00(1.00~1.00)	0.977
AFU(U/L)	1.00(1.00~1.01)	0.875
TBA(μmol/L)	0.99(0.98~0.99)	<0.001	0.99(0.98~1.00)	0.005
AFP (μg/L)	1.00(1.00~1.01)	<0.001	1.01(1.00~1.01)	<0.001
WBC(×10⁹/L)	1.07(1.00~1.14)	0.063
Plt(×10⁹/L)	1.00(1.00~1.00)	0.786

诊断变量	AUC（95%CI）	敏感度	特异度	阳性预测值	阴性预测值	统计值	P值
AFP	0.762（0.726~0.796）	0.506	0.898	0.765	0.735
AFP +年龄+性别	0.837（0.805~0.866）	0.649	0.856	0.746	0.789	Z=3.863	0.001
AFP +年龄+性别+ AST	0.871（0.841~0.897）	0.675	0.878	0.784	0.805	Z=5.076	<0.001
AFP +年龄+性别+ AST + TBA	0.878（0.849~0.903）	0.719	0.841	0.748	0.820	Z=5.363	<0.001

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