The Diagnostic Performance of AFP, AFP-L3, DCP, CA199, and Their Combination for Primary Liver Cancer

Yue Liu,* Wenrong Jiang,* Xiangxiao Li, Hu Zhao, Shiwen Wang Department of Laboratory Medicine, Huadong Hospital, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hu Zhao; Shiwen Wang, Department of Laboratory Medicine, Huadong Hospital, Fudan University, No. 221 West Yan’an Road, Shanghai, People’s Republic of China, Email [email protected]; [email protected]: The prevalence of primary liver cancer (PLC) is rising, yet strategies for its early diagnosis remain inadequate. This study aims to identify novel biomarkers to improve the diagnostic ability of PLC.Patients and Methods: This study included 94 patients with PLC, 128 patients with benign liver disease (BLD), and 79 normal controls (NC) were included. Among the PLC group, there were 39 patients with hepatocellular carcinoma (HCC), 14 patients with intrahepatic cholangiocarcinoma (ICC), 4 patients with combined hepatocellular-cholangiocarcinoma (CHC) and 37 patients with imaging-diagnosed HCC, respectively. Serum biomarkers and other laboratory parameters were collected and analyzed. Diagnostic values of individual and combined biomarkers for PLC were assessed using receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression identified predictors of PLC, and a nomogram model was developed based on the independent predictors.Results: AFP and DCP levels were significantly higher in the HCC patients compared to those with the BLD. AFP-L3 and CA199 levels were markedly elevated in patients with HCC, ICC, and CHC compared with the other groups. Combining AFP, AFP-L3, DCP, and CA199 increased the AUC to 0.8492 for the PLC group versus the BLD group. Multivariate logistic regression analysis identified sex, AFP-L3, DCP, and CA199 as independent predictors of PLC, and a reliable nomogram model was developed based on these predictors.Conclusion: The combined use of AFP, AFP-L3, DCP, and CA199 significantly enhanced the diagnostic performance of PLC compared with existing models like GALAD (gender, age, AFP, AFP-L3, and DCP), and ASAP (age, sex, AFP, DCP), as well as individual biomarkers.Keywords: serum biomarkers, ROC curve, nomogram, early diagnosis