Diagnostic value of gamma-glutamyltransferase/aspartate aminotransferase ratio, protein induced by vitamin K absence or antagonist II, and alpha-fetoprotein in hepatitis B virus-related hepatocellular carcinoma

BACKGROUND Researchers have investigated the diagnostic value of protein induced by vitamin K absence or antagonist II(PIVKA-II) and alpha-fetoprotein(AFP) in hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC), and obtained abundant clinical diagnostic data. However, PIVKA-II and AFP have unsatisfactory specificity and sensitivity in the diagnosis of early-stage HBV-related HCC.Gamma-glutamyltransferase(γ-GT) and aspartate aminotransferase(AST) are common biomarkers for evaluating liver function, and we hypothesized that theγ-GT/AST ratio in combination with PIVKA-II and AFP would improve the diagnosis of early-stage HBV-related HCC.AIM To evaluate the diagnostic value of γ-GT/AST ratio alone or in combination with PIVKA-II and AFP in HBV-related HCC.METHODS Serum levels of γ-GT, AST, PIVKA-II, and AFP were detected and analysed in176 patients with HBV-related HCC and in 359 patients with chronic hepatitis B.According to tumour size and serum level of HBV DNA, HBV-related HCC patients were divided into the following categories: Early-stage HCC patients,HCC patients, HBV DNA positive(HBV DNA+) HCC patients, and HBV DNA negative(HBV DNA-) HCC patients. Receiver-operating characteristic(ROC)curves were used to analyse and compare the diagnostic value of the single and combined detection of various biomarkers in different types of HBV-related HCC.RESULTS Tumour size was positively correlated with serum levels of PIVKA-II and AFP in HCC patients(r = 0.529, a P < 0.001 and r = 0.270, b P < 0.001, respectively), but there was no correlation between tumour size and the γ-GT/AST ratio(r = 0.073,P = 0.336). The areas under the receiver-operating characteristic curves(AUROCs) of the γ-GT/AST ratio in early-stage HCC patients, HBV DNA+ HCC patients and HBV DNA-HCC patients were not significantly different from that in the total HCC patients(0.754, 0.802, and 0.705 vs 0.779, respectively; P > 0.05).When PIVKA-II was combined with the γ-GT/AST ratio in the diagnosis of earlystage HCC, HCC, and HBV DNA+ HCC, the AUROCs of PIVKA-II increased,with values of 0.857 vs 0.835, 0.925 vs 0.913, and 0.958 vs 0.954, respectively. When AFP was combined with the γ-GT/AST ratio in the diagnosis of early-stage HCC,HCC, HBV DNA+ HCC, and HBV DNA-HCC, the AUROCs of AFP increased,with values of 0.757 vs 0.621, 0.837 vs 0.744, 0.868 vs 0.757, and 0.840 vs 0.828,respectively.CONCLUSION The γ-GT/AST ratio may be better than PIVKA-II and AFP in the diagnosis of early-stage HBV-related HCC, and its combination with PIVKA-II and AFP can improve the diagnostic value for HBV-related HCC.