Simplified HCC ART score for highly sensitive detection of small sized and early stage hepatocellular carcinoma in the widely used Okuda, CLIP, and BCLC staging systems
BackgroundSmall sized HCC can be effectively cured by surgery with good clinical outcomes. A highly sensitive HCC a fetoprotein routine test (HCC ART) for HCC diagnosis as well as a simplied form of the HCC ART were reported in the British Journal of Cancer. Here, we verified and studied the applicability of the HCC ART to the detection of early stage HCC.Methods341 cirrhotic patients and 318 HCC patients were included in this study. For each, the HCC ART score was calculated, and then the sensitivity, specificity, and results of an ROC curve analysis were compared between the HCC ART and AFP when these biomarkers were used to detect small sized HCC.ResultsDifferent HCC ART cutoffs were set for the detection of different tumor sizes. The HCC ART (AUC 0.871, 70% sensitivity, 97% specificity) and the simplified HCC ART (AUC 0.934, 82% sensitivity, 100% specificity) were found to have high predictive power when attempting to separate cirrhotic patients from those with small sized HCC. The simplified HCC ART score was superior to AFP for determining stages according to the early Okuda (0.950 AUC, 84% sensitivity, 99% specificity) CLIP (0.945 AUC, 84% sensitivity, 99% specificity) and BCLC (1.000 AUC, 100% sensitivity, 99% specificity) staging systems. The simplified HCC ART score was more strongly correlated than AFP and other staging systems with HCC tumor size (P 0.0001; r 0.8).ConclusionThe HCC ART is superior to AFP for diagnosing early stage HCC. Due to its advantages of minimal variability and a wide continuous scale for assessing HCC severity, the simplified HCC ART has the potential to be more widely used than the original HCC ART.
International Journal of Clinical Oncology