Background Alpha-fetoprotein (AFP) is of well-recognized as a tumor marker for screening hepatocellular carcinoma (HCC), but with a limited efficacy when used alone. In recent years, gamma-glutamyl transferase (GGT) has been recognized to play a vital role in the early diagnosis and prognosis assessment in patients with HCC. However, the clinical significance of AFP combined with GGT in screening HCC progression is still poorly understood.
Objective To investigate the clinical significance of AFP combined with GGT in predicting progressive disease (PD) treated by lenvatinib in male patients with advanced HBV-related HCC.
Methods A hospital-based retrospective study was conducted in 85 consecutive patients with advanced HBV-related HCC who had been treated with lenvatinib in the Fifth Medical Center of Chinese PLA General Hospital from June 2018 to June 2021. All patients were treated with lenvatinib as the first-line antitumor drug, according to the RECIST 1.1, the curative effectiveness was evaluated every 4-8 weeks, and the levels of AFP and GGT were also monitored. Patients were divided into PD group (n=22) and non-PD group (n=63) according to the evaluation of therapeutic effect of tumor-targeted therapy. The efficacy of AFP and GGT in predicting PD in male patients with advanced HBV-related HCC treated by lenvatinib was analyzed by the Receiver Operating Characteristic Curve (ROC).
Results There was no statistical significance in age, previous history, the score of Child-Pugh, the stage of BCLC, the score of performance status, the AFP level and GGT level between the two groups (all P>0.05). The AUC of ROC, sensitivity and specificity of △AFP in predicting PD in patients with hepatocellular carcinoma were 0.771 (95% CI: 0.647-0.896), 84.10%, 68.20%, respectively, they were 0.763 (95% CI: 0.629-0.898), 98.40%, 54.50% for △GGT, and 0.849 (95% CI: 0.744-0.954), 93.70%, 72.70% for the combined detection. The efficacy of combined detection in predicting PD was higher than that of AFP (P=0.0233). The optimal cut-off value of △AFP difference was 52 ng/mL, and 21.5 U/L for △GGT.
Conclusion The combination of AFP and GGT is valuable in predicting disease progression in patients with HBV-related HCC.
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