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Significance of this study
What is already known?
AFP has been the only standard serum marker for the detection of HCC for the last 40 years, even though its sensitivity of 39-65% is unsatisfactory.
Golgi protein 73 (GP73) is a potential serum marker for HCC but has not been validated in large cohort studies.
Whether GP73 is a better serum biomarker than AFP is controversial.
What are the new findings?
Combined measurement of GP73 and AFP increased the sensitivity for HCC to 89.2% (95% CI 86.7% to 91.5%), with a specificity of 85.2% (95% CI 83.4% to 86.4%).
GP73 decreased following surgical resection of HCC lesions and increased with tumour recurrence.
Non-liver cancers in 14 organs (colon, rectum, stomach, oesophagus, pancreas, lung, thyroid, kidney, bladder, prostate, breast, ovary, cervix and endometrium) were analysed; all the benign and other malignant liver lesions had moderate elevations of GP73, albeit at a much lower level than in HCC.
How might it impact on clinical practice in the foreseeable future?
Combined measurement of AFP and GP73 shows promise to improve the detection and treatment of HCC.
Introduction
Hepatocellular carcinoma (HCC) is strongly associated with either chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, 1-3 and is the fifth most common cancer and the third leading cause of cancer death worldwide. 1-4 In the USA, the incidence of HCC is increasing faster than that of any other cancer. 5 Notably, HCC is a leading cause of cancer death in China. In China, 7.18% of the entire population are HBV carriers (93 million, two-thirds of the world's total number of carriers); Chinese HCC patients account for >55% of new HCC cases worldwide (Global Cancer Facts & Figures 2007, American Cancer Society). 4 6 A 10-year survey (1990-2001) conducted in China indicates that HCC ranks first among chronic diseases for the social cost and burden in the WHO 'disability-adjusted life year (DALY)' list. 7 The 5-year survival rate of all HCC is <5%, placing it among the cancers with the worst prognosis. 2 5 8 The prognosis can be significantly improved by early diagnosis and treatment. 1
The use of serological markers in patients at the highest risk for developing HCC can thus decrease the cancer-related mortality and...