The diagnostic value of the combination of Golgi protein 73, glypican-3 and alpha-fetoprotein in hepatocellular carcinoma: a diagnostic meta-analysis

Abstract

Background: Alpha-fetoprotein (AFP) has been extensively applied in clinical practice to detect and predict postoperative outcomes of patients with hepatocellular carcinoma (HCC). However, due to its low sensitivity and specificity, its efficacy has been questioned. Recently, novel serum biomarkers including Golgi protein 73 (GP73) and glypican-3 (GPC-3) have shown a better discriminatory ability than AFP in detecting early HCC. The results of the combined use of GP73, GPC-3 and AFP in the diagnosis of HCC remain inconclusive. This investigation aimed to evaluate the discriminatory ability of GP73, GPC-3 and AFP to jointly identify HCC using the statistical methods of meta-analysis.Methods: Comprehensive database searches of , Web of Science, the Cochrane Library, Embase, the Chinese Biomedical Literature Database, and the China National Knowledge Infrastructure were performed for literature dated up to 1 November, 2019. Studies relating to the diagnostic accuracy of the combination of GP73, GPC-3 and AFP in the identification of HCC were included. A random-effects model was used to pool sensitivity, specificity, the positive and negative likelihood ratios [positive likelihood ratio (PLR) and negative likelihood ratio (NLR), respectively], and the diagnostic odds ratio (DOR). We applied the Fagan nomogram to assess the clinical utility of joint detection. The overall detection accuracy was determined using summary receiver operating characteristic curve (SROC) analysis. Meta-regression analysis of heterogeneity publication bias was analyzed with Stata (version 12.0). Results:Our meta-analysis focused on 12 studies involving 919 patients with HCC and 1,549 non-HCC patients. Sensitivity, specificity, PLR, NLR and DOR for joint detection, were 0.91 (95%

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“…Therefore, early diagnosis of HCC is particularly important. The current screening methods for HCC, such as ultrasound and serum alpha-fetoprotein (AFP), are less effective because of their low specificity and sensitivity ( 4 ). Therefore, many scholars have been trying to find new HCC markers and related molecules to improve the rate of early diagnosis.…”

Serum Biomarkers for the Prediction of Hepatocellular Carcinoma

“…The second meta-analysis evaluated the performance of glypican-3, Golgi protein 73 and AFP levels. These three biomarkers combined had an AUROC of 0.95 and performed better than any biomarker alone or any pair of biomarkers [ 29 ].…”

Serum Cartilage Oligomeric Matrix Protein and Golgi Protein-73: New Diagnostic and Predictive Tools for Liver Fibrosis and Hepatocellular Cancer?

“…In general, the combination of various biomarkers in order to further improve the diagnostic accuracy for detecting severe fibrosis and cirrhosis as well as to facilitate the early detection of HCC seems promising and attractive [ 50 , 51 , 52 ]. Several combinations have been proposed, such as the SAFE biopsy algorithm for the non-invasive assessment of liver fibrosis, which consists of APRI and a commercialized method (Fibrotest-Fibrosure) [ 53 ] or the combination of GP73, glypican-3, and AFP for the diagnosis of HCC [ 54 ]. However, several aspects should be taken into account when using these combination markers, such as the cut-off levels, characteristics of the control groups used during their validation, the tumor burden of patients, the exact algorithm, and whether the same algorithm has been applied in other studies.…”