Active viral activity of HCV was considered if there was either detectable HCV RNA or grade 2 or higher HCV inflammation on corresponding histopathology.[14, 15] Active HBV activity was considered if there was presence of HBV DNA ≥ 104 copies/mL. In cases with co-infection by HCV and HBV, either active HCV or HBV was considered active viral activity. In non-viral-related liver diseases, the Child-Pugh classification
was used to assess liver status between abnormal ALT and normal ALT cases. The non-viral-related liver BGB324 order diseases in this study included alcoholic liver disease, non-alcoholic steatohepatitis, primary biliary cirrhosis, autoimmune hepatitis, and glycogen storage disease. After applying an AFP cutoff of ≥ 20 ng/mL for both AFP-producing HCC and positive HCC recurrence, there were a number of false positive and false negative results. The majority of false positive AFP was within 100 ng/mL and most of these cases were associated with abnormal ALT. Therefore, we propose two sets of modified AFP criteria
for both AFP-producing HCC and recurrent HCC which have been adjusted for patients with elevated ALT (≥ 40 U/L) to eliminate LY2606368 false interpretations from liver inflammation. Increased inflammatory activity independent of HCC could miscategorize non-AFP-producing tumors as AFP-producing HCC and thus produce false positive recurrences after RFA. The details of the two modified criteria are shown in Table 1. The diagnostic performance of AFP using the modified cutoff levels were calculated and compared.
Baseline characteristics of all patients were analyzed by descriptive statistics. Skewed variables including AFP, ALT, and AST were estimated using median and interquartile range (IQR). Continuous variables were compared using the Mann–Whitney U-test or the Student’s t-test, and by using the Chi-square or Fisher’s exact test for categorical Branched chain aminotransferase variables. The performance of AFP in the detection of HCC recurrence was evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Analyses were conducted using SPSS software (version 20 IBM, New York, NY, USA) with a two-sided P value < 0.05 set as the level of significance. In multiple comparison analysis, an adjusted P value was applied using Bonferroni correction. There were 146 RFA treatment courses for solitary HCC in 131 patients eligible for the study. Of these patients, a majority of the patients were male (73.3%) with a mean age of 64.1 ± 10.6 (standard deviation) years. The mean baseline and recurrent tumor sizes were 2.4 cm and 2.6 cm, respectively. The median follow-up time after the first RFA was 8.2 months. The gender, age, pretreatment serum AFP level, liver function tests, underlying liver diseases, Child-Pugh classification, and diagnostic criteria for recurrence are shown in Table 2. Of 146 treated HCCs, 103 demonstrated no tumor recurrence at last follow-up while 43 HCC had local recurrences.