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Preoperative diagnosis of poorly differentiated grade in patients with large hepatocellular carcinoma: A prospective controlled study
Abstracts / Digestive and Liver Disease 41 (2009) A1–A19
COMBINING SCCA-IGM AND AFP-IGM LEVELS INCREASES ACCURACY OF HEPATOCELLULAR CARCINOMA DETECTION A. Gallotta a , J. Zuin a , G. Veggiani a , P. Pengo a , A. Biasiolo b , N. Tono c , A. Gatta b , P. Pontisso b , G. Fassina a , L. Beneduce a a XEPTAGEN SpA, Via delle Industrie 9, Marghera, Venezia, Italy b Department of Clinical and Experimental Medicine, Via Giustiniani 2, University of Padua, Padua, Italy c Istituto Oncologico Veneto - I.O.V. (IRCCS), Padua, Italy
Background and AIm. The assessment of serum levels of SCCA-IgM or AFP-IgM immune complexes may improve diagnosis of HCC and may also predict the progression of cirrhosis to HCC. Simulation studies on multiple diagnostic assays of cancer biomarkers suggest to combine biomarkers by linear logistic regression in order to optimize diagnostic accuracy. Aim of the study was to evaluate the diagnostic accuracy improvement in HCC by SCCA-IgM and AFP-IgM combination in sera of HCC and cirrhotic patients. Patients and methods. Serum samples from 81 patients with HCC (mean age ± SD = 63 ± 8) and 82 patients with cirrhosis (mean age ± SD = 53 ± 9) were collected. Hepatitis C virus infection was the most recurrent etiologic agent among groups. The logistic regression’s parameters were calculated on a previously published data set of 50 patients with HCC and 50 patients with cirrhosis, where the distribution of serum levels of SCCA-IgM and of AFP-IgM in HCC patients was significantly different from cirrhotic patients (Mann–Whitney U test, p < 0.01). Results. The diagnostic accuracy measured as the area under the ROC curve (AUC) for SCCA-IgM and AFP-IgM assay was roughly the same in the data set of this study with a weak supremacy of SCCA-IgM (AUC = 0.58). The combination of serum levels of SCCA-IgM and AFP-IgM using a linear logistic regression model with calculated parameters significantly enhanced the diagnostic accuracy up to 40% (AUC = 0.73). When the estimation of the partial AUC (pAUC0.3 ), an alternative measurement of AUC that takes into consideration only specificity values with clinical relevance (specificity > 70%), the highest improvement of HCC detection was obtained with an increase of up to 80%. Conclusions. The study results demonstrate that the combination of SCCA-IgM and AFP-IgM by logistic regression leads to improved accuracy of HCC detection. doi:10.1016/j.dld.2009.02.038
A15
PREOPERATIVE DIAGNOSIS OF POORLY DIFFERENTIATED GRADE IN PATIENTS WITH LARGE HEPATOCELLULAR CARCINOMA: A PROSPECTIVE CONTROLLED STUDY A. Vitale a , M. Guido b , M. Costantin c , A. Fassina c , M. Rugge b , G. Zanus d , A. Brolese d , F. D’Amico d , U. Cillo d a
Istituto Oncologico Veneto, IRCCS, Unità di Chirurgia Oncologica, Padova, Italy b Istituto Oncologico Veneto, IRCCS, Unità di Anatomia Patologica, Padova, Italy c Unità di Anatomia Patologica, Università di Padova, Servizio di Citodiagnostica, Padova, Italy d Azienda - Università di Padova, Unità di Chirurgia Epatobiliare e Trapianto Epatico, Padova, Italy Background/Aims. In patients with a large hepatocellular carcinoma (LHCC: tumor diameter larger than 3 cm), surgical treatment is the only potentially radical surgery. Tumor grade is the main predictor of post-surgical HCC recurrence, but preoperative biopsy has shown a poor diagnostic sensibility, especially in patients with LHCC. The aim of this study is to increase the diagnostic sensibility of preoperative biopsy in detecting pathologic poorly differentiated grade (PDG) by an association of needle and core sample procedures. Methods. Thirty patients with LHCC undergoing both needle and core biopsies before surgery were prospectively enrolled and represented the study group. An historical cohort of 44 patients with LHCC undergoing a single diagnostic procedure (needle or core biopsy) before surgery represented the control group. In both groups, the diagnostic agreement of preoperative biopsy PDG detection was compared with the final surgical pathologic PDG diagnosis as reference. Results. Baseline clinical characteristics were comparable in the 2 groups. Pre and post surgical histological evaluations in both groups were done in the same pathologic Institute. There were no false positive cases in both groups (specificity = 100%). In the study group, 7/11 (sensibility = 64%) PDG cases were correctly predicted before surgery, whereas there were only 4/11 (sensibility = 36%) in the control group (p < .05). Conclusions. The association of needle and core biopsy in patients with LHCC has the potential to significantly increase the sensibility of preoperative PDG HCC diagnosis. Moreover, preoperative biopsy, single or double, showed a very high specificity (100%) in detecting PDG HCC cases. doi:10.1016/j.dld.2009.02.039
COMBINING SCCA-IGM AND AFP-IGM LEVELS INCREASES ACCURACY OF HEPATOCELLULAR CARCINOMA DETECTION A. Gallotta a , J. Zuin a , G. Veggiani a , P. Pengo a , A. Biasiolo b , N. Tono c , A. Gatta b , P. Pontisso b , G. Fassina a , L. Beneduce a a XEPTAGEN SpA, Via delle Industrie 9, Marghera, Venezia, Italy b Department of Clinical and Experimental Medicine, Via Giustiniani 2, University of Padua, Padua, Italy c Istituto Oncologico Veneto - I.O.V. (IRCCS), Padua, Italy
Background and AIm. The assessment of serum levels of SCCA-IgM or AFP-IgM immune complexes may improve diagnosis of HCC and may also predict the progression of cirrhosis to HCC. Simulation studies on multiple diagnostic assays of cancer biomarkers suggest to combine biomarkers by linear logistic regression in order to optimize diagnostic accuracy. Aim of the study was to evaluate the diagnostic accuracy improvement in HCC by SCCA-IgM and AFP-IgM combination in sera of HCC and cirrhotic patients. Patients and methods. Serum samples from 81 patients with HCC (mean age ± SD = 63 ± 8) and 82 patients with cirrhosis (mean age ± SD = 53 ± 9) were collected. Hepatitis C virus infection was the most recurrent etiologic agent among groups. The logistic regression’s parameters were calculated on a previously published data set of 50 patients with HCC and 50 patients with cirrhosis, where the distribution of serum levels of SCCA-IgM and of AFP-IgM in HCC patients was significantly different from cirrhotic patients (Mann–Whitney U test, p < 0.01). Results. The diagnostic accuracy measured as the area under the ROC curve (AUC) for SCCA-IgM and AFP-IgM assay was roughly the same in the data set of this study with a weak supremacy of SCCA-IgM (AUC = 0.58). The combination of serum levels of SCCA-IgM and AFP-IgM using a linear logistic regression model with calculated parameters significantly enhanced the diagnostic accuracy up to 40% (AUC = 0.73). When the estimation of the partial AUC (pAUC0.3 ), an alternative measurement of AUC that takes into consideration only specificity values with clinical relevance (specificity > 70%), the highest improvement of HCC detection was obtained with an increase of up to 80%. Conclusions. The study results demonstrate that the combination of SCCA-IgM and AFP-IgM by logistic regression leads to improved accuracy of HCC detection. doi:10.1016/j.dld.2009.02.038
A15
PREOPERATIVE DIAGNOSIS OF POORLY DIFFERENTIATED GRADE IN PATIENTS WITH LARGE HEPATOCELLULAR CARCINOMA: A PROSPECTIVE CONTROLLED STUDY A. Vitale a , M. Guido b , M. Costantin c , A. Fassina c , M. Rugge b , G. Zanus d , A. Brolese d , F. D’Amico d , U. Cillo d a
Istituto Oncologico Veneto, IRCCS, Unità di Chirurgia Oncologica, Padova, Italy b Istituto Oncologico Veneto, IRCCS, Unità di Anatomia Patologica, Padova, Italy c Unità di Anatomia Patologica, Università di Padova, Servizio di Citodiagnostica, Padova, Italy d Azienda - Università di Padova, Unità di Chirurgia Epatobiliare e Trapianto Epatico, Padova, Italy Background/Aims. In patients with a large hepatocellular carcinoma (LHCC: tumor diameter larger than 3 cm), surgical treatment is the only potentially radical surgery. Tumor grade is the main predictor of post-surgical HCC recurrence, but preoperative biopsy has shown a poor diagnostic sensibility, especially in patients with LHCC. The aim of this study is to increase the diagnostic sensibility of preoperative biopsy in detecting pathologic poorly differentiated grade (PDG) by an association of needle and core sample procedures. Methods. Thirty patients with LHCC undergoing both needle and core biopsies before surgery were prospectively enrolled and represented the study group. An historical cohort of 44 patients with LHCC undergoing a single diagnostic procedure (needle or core biopsy) before surgery represented the control group. In both groups, the diagnostic agreement of preoperative biopsy PDG detection was compared with the final surgical pathologic PDG diagnosis as reference. Results. Baseline clinical characteristics were comparable in the 2 groups. Pre and post surgical histological evaluations in both groups were done in the same pathologic Institute. There were no false positive cases in both groups (specificity = 100%). In the study group, 7/11 (sensibility = 64%) PDG cases were correctly predicted before surgery, whereas there were only 4/11 (sensibility = 36%) in the control group (p < .05). Conclusions. The association of needle and core biopsy in patients with LHCC has the potential to significantly increase the sensibility of preoperative PDG HCC diagnosis. Moreover, preoperative biopsy, single or double, showed a very high specificity (100%) in detecting PDG HCC cases. doi:10.1016/j.dld.2009.02.039