Predictability of liver-related seromarkers for the risk of hepatocellular carcinoma in chronic hepatitis B patients

Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) is a major global health problem. A few risk calculators have been developed using mainly HBV seromarkers as predictors. However, serum HBV DNA level, HBV genotype, and mutants are not routinely checked in regular health examinations. Th...

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Published in:	PloS one 2013-04, Vol.8 (4), p.e61448
Main Authors:	Lin, Yu-Ju, Lee, Mei-Hsuan, Yang, Hwai-I, Jen, Chin-Lan, You, San-Lin, Wang, Li-Yu, Lu, Sheng-Nan, Liu, Jessica, Chen, Chien-Jen
Format:	Article
Language:	eng
Subjects:	Adult Alanine Alanine transaminase Albumin Alcohol Antigens Apolipoprotein B Apolipoproteins Area Under Curve Aspartate Aspartate aminotransferase Bilirubin Biomarkers, Tumor - blood Calculators Carcinoma, Hepatocellular - blood Carcinoma, Hepatocellular - epidemiology Carcinoma, Hepatocellular - etiology Cohort Studies Confidence intervals Deoxyribonucleic acid DNA Epidemiology Family medical history Female Genomics Global health Globulins Hazards Health care Health risks Hepatitis Hepatitis B Hepatitis B, Chronic - complications Hepatitis B, Chronic - epidemiology Hepatitis C virus Hepatocellular carcinoma Hepatoma Humans Incidence Infections Interferon Liver Liver - metabolism Liver cancer Liver diseases Liver Neoplasms - blood Liver Neoplasms - epidemiology Liver Neoplasms - etiology Male Medical examination Medical research Medicine Medicine, Experimental Middle Aged Multivariate Analysis Mutants Patients Periodic health examinations Physical diagnosis Predictability Preventive medicine Proportional Hazards Models Proteins Public health Regression analysis Regression coefficients Regression models Reproducibility of Results Risk analysis Risk Factors ROC Curve Serum levels Statistical analysis Viruses α-Fetoprotein γ-Glutamyltransferase
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Summary:	Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) is a major global health problem. A few risk calculators have been developed using mainly HBV seromarkers as predictors. However, serum HBV DNA level, HBV genotype, and mutants are not routinely checked in regular health examinations. This study aimed to assess the predictability of HCC risk in chronic hepatitis B patients, using a combination of liver-related seromarkers combined with or without HBV seromarkers. A prospective cohort of 1,822 anti-HCV-seronegative chronic HBV carriers was included in this study. Liver-related seromarkers including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-fetoprotein (AFP), gamma-glutamyltransferase (GGT), total bilirubin, total protein, albumin, serum globulins, apolipoprotein A1, and apolipoprotein B were examined. Hazard ratios of HCC with 95% confidence intervals were estimated using Cox proportional hazards regression models. Regression coefficients of seromarkers significantly associated with HCC risk in multivariate analyses were used to create integer risk scores. The predictability of various risk models were assessed by area under receiver operating characteristic curves (AUROCs). During a median follow-up of 5.9 years, 48 newly-developed HCC cases were ascertained. Elevated serum levels of ALT (≥ 28 U/L), AFP (≥ 5 ng/mL), and GGT (≥ 41 U/L), an increased AST/ALT ratio (AAR, ≥ 1), and lowered serum levels of albumin (≤ 4.1 g/dL) and alpha-1 globulin (≤ 0.2 g/dL) were significantly associated with an increased HCC risk (P
ISSN:	1932-6203 1932-6203