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The Alpha-fetoprotein Serum is still Reliable as a Biomarker for the Surveillance of Hepatocellular Carcinoma in Indonesia
Chyntia Olivia Maurine Jasirwan
Hepatobilary Division
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5950-8245
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Gastroenterology.
Background and Aims Hepatocellular carcinoma (HCC), the most common type of liver cancer, is one of the leading causes of cancer-related death worldwide with an inferior prognosis. In Indonesia, the average life expectancy is less than 5 months, with most patients being in an advanced stage wherein the survival rate is very low. Early detection through surveillance program is very crucial. HCC guidelines worldwide have provided surveillance recommendation through the examination of α-fetoprotein (AFP) and ultrasound for patients at risk in developing HCC. However, there have been some controversies regarding the usage of AFP concerning its low sensitivity and specificity in detecting HCC. Therefore, the effectiveness of AFP in the surveillance of HCC patients and identifying the parameters most associated with the increase of AFP≥10 ng/ml in Indonesia should be evaluated.
Methods We analyzed medical records of HCC patients and those at high risk of developing HCC through cross-sectional study, including patients with cirrhosis and hepatitis B and C, from 2015 to 2017 who underwent treatment at the Cipto Mangunkusumo National Hospital and Dharmais National Cancer Hospital, Indonesia.
Results The sensitivity and specificity of AFP in the surveillance of HCC in Indonesia with a cut-off of 10 ng/ml were 82.6% and 71.2%, respectively. The parameters most associated with the increase of AFP ≥10 ng/ml according to multivariate analysis were the etiology of hepatitis B, the stage of Barcelona Clinic Liver Cancer B and C, and the presence of cirrhosis, respectively.
Conclusion AFP can still be used in the surveillance of HCC in Indonesia for its high sensitivity value.
Keywords
α-fetoprotein, hepatocellular carcinoma, surveillance, biomarker
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CURRENT STATUS: Published
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Posted 13 Apr, 2020
Published
On 09 Jul, 2020
No community comments so far
Editorial decision: Major revision
On 04 May, 2020
Review #2 received
Received 03 May, 2020
Review #1 received
Received 29 Apr, 2020
Reviewer #2 agreed
On 13 Apr, 2020
Reviewer #1 agreed
On 08 Apr, 2020
Editor assigned
On 07 Apr, 2020
Reviewers invited
Invitations sent on 07 Apr, 2020
Submission checks complete
On 06 Apr, 2020
Editor invited
On 06 Apr, 2020
No comments provided
Editorial decision: Major revision
On 11 Mar, 2020
Review #2 received
Received 10 Mar, 2020
Review #1 received
Received 08 Mar, 2020
Reviewer #2 agreed
On 04 Mar, 2020
Reviewer #1 agreed
On 24 Feb, 2020
Editor assigned
On 22 Feb, 2020
Reviewers invited
Invitations sent on 22 Feb, 2020
Submission checks complete
On 18 Feb, 2020
Editor invited
On 18 Feb, 2020
First submitted
On 10 Feb, 2020
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This preprint is under consideration at BMC Gastroenterology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
The Alpha-fetoprotein Serum is still Reliable as a Biomarker for the Surveillance of Hepatocellular Carcinoma in Indonesia
Chyntia Olivia Maurine Jasirwan
Hepatobilary Division
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5950-8245
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 13 Apr, 2020
Published
On 09 Jul, 2020
No community comments so far
Editorial decision: Major revision
On 04 May, 2020
Review #2 received
Received 03 May, 2020
Review #1 received
Received 29 Apr, 2020
Reviewer #2 agreed
On 13 Apr, 2020
Reviewer #1 agreed
On 08 Apr, 2020
Editor assigned
On 07 Apr, 2020
Reviewers invited
Invitations sent on 07 Apr, 2020
Submission checks complete
On 06 Apr, 2020
Editor invited
On 06 Apr, 2020
No comments provided
Editorial decision: Major revision
On 11 Mar, 2020
Review #2 received
Received 10 Mar, 2020
Review #1 received
Received 08 Mar, 2020
Reviewer #2 agreed
On 04 Mar, 2020
Reviewer #1 agreed
On 24 Feb, 2020
Editor assigned
On 22 Feb, 2020
Reviewers invited
Invitations sent on 22 Feb, 2020
Submission checks complete
On 18 Feb, 2020
Editor invited
On 18 Feb, 2020
First submitted
On 10 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Gastroenterology.
Background and Aims Hepatocellular carcinoma (HCC), the most common type of liver cancer, is one of the leading causes of cancer-related death worldwide with an inferior prognosis. In Indonesia, the average life expectancy is less than 5 months, with most patients being in an advanced stage wherein the survival rate is very low. Early detection through surveillance program is very crucial. HCC guidelines worldwide have provided surveillance recommendation through the examination of α-fetoprotein (AFP) and ultrasound for patients at risk in developing HCC. However, there have been some controversies regarding the usage of AFP concerning its low sensitivity and specificity in detecting HCC. Therefore, the effectiveness of AFP in the surveillance of HCC patients and identifying the parameters most associated with the increase of AFP≥10 ng/ml in Indonesia should be evaluated.
Methods We analyzed medical records of HCC patients and those at high risk of developing HCC through cross-sectional study, including patients with cirrhosis and hepatitis B and C, from 2015 to 2017 who underwent treatment at the Cipto Mangunkusumo National Hospital and Dharmais National Cancer Hospital, Indonesia.
Results The sensitivity and specificity of AFP in the surveillance of HCC in Indonesia with a cut-off of 10 ng/ml were 82.6% and 71.2%, respectively. The parameters most associated with the increase of AFP ≥10 ng/ml according to multivariate analysis were the etiology of hepatitis B, the stage of Barcelona Clinic Liver Cancer B and C, and the presence of cirrhosis, respectively.
Conclusion AFP can still be used in the surveillance of HCC in Indonesia for its high sensitivity value.
Figure 1
Figure 2