Determinants of alpha‐fetoprotein levels in patients with hepatocellular carcinoma: Implications for its clinical use
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- Edoardo G. Giannini
- Gastroenterology Unit Department of Internal Medicine IRCCS‐University Hospital San Martino‐IST, University of Genoa Genoa Italy
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- Giorgio Sammito
- Gastroenterology Unit Department of Internal Medicine IRCCS‐University Hospital San Martino‐IST, University of Genoa Genoa Italy
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- Fabio Farinati
- Gastroenterology Unit Department of Surgical and Gastroenterological Sciences University of Padua Padua Italy
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- Francesca Ciccarese
- Division of Surgery San Marco Polyclinic Zingonia Italy
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- Anna Pecorelli
- Internal Medicine Unit Department of Gastroenterology and Internal Medicine Alma Mater Studiorum‐Univeristy of Bologna Bologna Italy
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- Gian Lodovico Rapaccini
- Unit of Internal Medicine and Gastroenterology Columbus Integrated Complex Catholic University of Rome Rome Italy
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- Mariella Di Marco
- Division of Medicine Bolognini Teaching Hospital Seriate Italy
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- Eugenio Caturelli
- Operative Gastroenterology Unit Belcolle Hospital Viterbo Italy
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- Marco Zoli
- Internal Medicine Unit Department of Medical and Surgical Sciences Alma Mater Studiorum‐University of Bologna Bologna Italy
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- Franco Borzio
- Radiology Unit Department of Medicine Fatebenefratelli Hospital Milan Milan Italy
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- Giuseppe Cabibbo
- Gastroenterology Unit Biomedical Department of Internal and Specialty Medicine University of Palermo Palermo Italy
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- Martina Felder
- Gastroenterology Unit Bolzano Regional Hospital Bolzano Italy
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- Antonio Gasbarrini
- Unit of Internal Medicine and Gastroenterology Gemelli Polyclinic Catholic University of Rome Rome Italy
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- Rodolfo Sacco
- Operative Unit for Gastroenterology and Metabolic Diseases Teaching Hospital‐University of Pisa Pisa Italy
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- Francesco Giuseppe Foschi
- Department of Internal Medicine Faenza Hospital for the Infirm Faenza Italy
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- Gabriele Missale
- Unit of Infectious Diseases and Hepatology Teaching Hospital‐University of Parma Parma Italy
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- Filomena Morisco
- Gastroenterology Unit Department of Clinical Medicine and Surgery Federico II University of Naples Naples Italy
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- Gianluca Svegliati Baroni
- Gastroenterology Clinic Marche Polytechnic University Ancona Italy
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- Roberto Virdone
- Internal Medicine Unit 2 Biomedical Department of Internal and Specialty Medicine Villa Sofia‐Cervello United Hospitals Palermo Italy
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- Franco Trevisani
- Medical Semeiotics Unit Department of Medical and Surgical Sciences Alma Mater Studiorum‐University of Bologna Bologna Italy
抄録
<jats:sec><jats:title>BACKGROUND</jats:title><jats:p>α‐Fetoprotein (AFP) is a biomarker commonly used in the management of patients with hepatocellular carcinoma (HCC), although the possible determinants of its serum levels in these patients have not been adequately explored. For this study, the authors evaluated the relevance of demographic, clinical, and oncologic factors to the presence of elevated AFP levels in large cohort of patients with HCC.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>In 4123 patients with HCC who were managed by the Italian Liver Cancer Group, AFP levels were assessed along with their association with demographic, biochemical, clinical, and oncologic characteristics. Patients were subdivided according to the presence of elevated AFP (ie, >10 ng/mL).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>AFP levels were elevated in 62.4% of patients with HCC. Multivariate logistic regression analysis indicated that being a woman (odds ratio [OR], 1.497; 95% confidence interval [95%CI], 1.250‐1.793; <jats:italic>P</jats:italic> < .0001), the presence of cirrhosis (OR, 1.538; 95% CI, 1.050‐2.254; <jats:italic>P</jats:italic> = .027), liver disease with viral etiology (OR, 1.900; 95% CI, 1.589‐2.272; <jats:italic>P</jats:italic> < .0001), an elevated alanine aminotransferase level (OR, 1.878; 95% CI, 1.602‐2.202; <jats:italic>P</jats:italic> < .0001), a low albumin level (OR, 1.301; 95% CI, 1.110‐1.525; <jats:italic>P</jats:italic> = .012), an HCC tumor size >2 cm (OR, 1.346; 95% CI, 1.135‐2.596; <jats:italic>P</jats:italic> = .001), multinodular HCC (OR, 1.641; 95% CI, 1.403‐1.920; <jats:italic>P</jats:italic> < .0001), and the presence of vascular invasion (OR, 1.774; 95% CI, 1.361‐2.311; <jats:italic>P</jats:italic> < .0001) were associated independently with elevated levels of AFP. Both the median AFP level and the proportion of patients who had elevated levels increased with decreasing degrees of HCC differentiation (<jats:italic>P</jats:italic> < .0001).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Sex and features of chronic liver disease were identified as nontumor characteristics that influence serum AFP levels in patients with HCC. These findings should be taken into account as limitations in interpreting the oncologic meaning of this biomarker in clinical practice. <jats:bold><jats:italic>Cancer</jats:italic> 2014;120:2150–2157</jats:bold>. © <jats:italic>2014 American Cancer Society</jats:italic>.</jats:p></jats:sec>
収録刊行物
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- Cancer
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Cancer 120 (14), 2150-2157, 2014-04-10
Wiley