Combination of squamous cell carcinoma antigen immunocomplex and alpha-fetoprotein in mid- And long-term prediction of hepatocellular carcinoma among cirrhotic patients
Por:
Gil-Gómez A., Rojas Á., Gallego-Duran R., Muñoz-Hernandez R., Ampuero J., Romero-Gómez M., Liu C.-H., Fassina G., Pontisso P.
Publicada:
1 ene 2021
Resumen:
BACKGROUND The combination of alpha-fetoprotein (AFP) and squamous cell carcinoma antigen immunocomplex (SCCA-IgM) have been proposed for its use in the screening of hepatocellular carcinoma (HCC). Current screening programs for all cirrhotic patients are controversial and a personalized screening is an unmet need in the precision medicine era. AIM To determine the role of the combination of SCCA-IgM and AFP in predicting mid- and long-term appearance of HCC. METHODS Two-hundred and three cirrhotic patients (Child A 74.9%, B 21.2%, C 3.9%) were followed-up prospectively every six months to screen HCC by ultrasound and AFP according to European Association for the Study of the Liver guidelines. The estimation cohort was recruited in Italy (30.5%; 62/203) and validation cohort from Spain (69.5%; 141/203). Patients underwent to evaluate SCCA-IgM by enzyme-linked immunosorbent assay (Hepa-IC, Xeptagen, Italy) and AFP levels at baseline. Patients were followed-up for 60 mo, being censored at the time of the appearance of HCC. RESULTS There were 10.8% and 23.1% of HCC development at two- and five-years followup. Patients with HCC showed higher levels of SCCA-IgM than those without it (425.72 ± 568.33 AU/mL vs 195.93 ± 188.40 AU/mL, P = 0.009) during the fiveyear follow-up. In multivariate analysis, after adjusting by age, sex, aspartate transaminase and Child-Pugh, the following factors were independently associated with HCC: SCCA-IgM [Hazard ratio (HR) = 1.001, 95%CI: 1.000-1.002; P = 0.003], AFP (HR = 1.028, 95%CI: 1.009-1.046; P = 0.003) and creatinine (HR = 1.564 95%CI: 1.151-2.124; P = 0.004). The log-rank test of the combination resulted in 7.488 (P = 0.024) in estimation cohort and 11.061 (P = 0.004) in the validation cohort, and a 100% of correctly classified rate identifying a low-risk group in both cohorts in the two-year follow-up. CONCLUSION We have constructed a predictive model based on the combination of SCCA-IgM and AFP that provides a new HCC screening method, which could be followed by tailored HCC surveillance for individual patients, especially for those cirrhotic patients belonging to the subgroup identified as low-risk of HCC development. © The Author(s) 2021.
Filiaciones:
Gil-Gómez A.:
SeLiver Group, Institute of Biomedicine of Seville, Seville, 41013, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, 28029, Spain
Mucosal Immunity Lab, IRCCS Humanitas Research Hospital, Milan, 20089, Italy
Rojas Á.:
SeLiver Group, Institute of Biomedicine of Seville, Seville, 41013, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, 28029, Spain
Gallego-Duran R.:
SeLiver Group, Institute of Biomedicine of Seville, Seville, 41013, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, 28029, Spain
Muñoz-Hernandez R.:
SeLiver Group, Institute of Biomedicine of Seville, Seville, 41013, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, 28029, Spain
Ampuero J.:
SeLiver Group, Institute of Biomedicine of Seville, Seville, 41013, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, 28029, Spain
UCM Digestive Diseases, Virgen del Rocío University Hospital, Seville, 41014, Spain
Romero-Gómez M.:
SeLiver Group, Institute of Biomedicine of Seville, Seville, 41013, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, 28029, Spain
UCM Digestive Diseases, Virgen del Rocío University Hospital, Seville, 41014, Spain
Liu C.-H.:
Center of Infectious Diseases, West China Hospital, Sichuan University, Sichuan Province, Chengdu, 610017, China
State Key Laboratory of Biotherapy, Center of Infectious Diseases, West China Hospital, Sichuan Province, Chengdu, 610017, China
Fassina G.:
Life Biotechnology, Padua University, Venice, 30175, Italy
Pontisso P.:
Department of Clinical and Experimental Medicine, University of Padova, Padova, 35123, Italy
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