A logistic model established with routine blood laboratory tests for the diagnosis of AFP negative hepatic carcinoma

Objective: The diagnosis of alpha-fetoprotein negative hepatic carcinoma (AFPNHC) is a big challenge in clinical practice. This study was aimed at estalishing a mathmetical model with routine laboratory tests and evaluating its value in the diagnosis of AFPNHC. Methods: The medical records of patients with liver diaseases hospitalized in the First Affiliated Hospital of Nanchang University during 2009-2012 were reviewed, and the clinical data of primary hepatic carcinoma cases with with serum AFP < 20μg/L before therapy were collected, including gender, age and all blood test results. And the clinical data of chronic liver disease (cirrhosis and hepatitis B) (CLD) cases with serum AFP assay before therapy were also collected upto 100 cases each year. Two third of subjects were randomly selected as training set to establish diagnostic model for AFPNHC by multivariate stepwise logistic regression analysis, and the other subjects were used as validation set to validate the model. Results: Atotal of 1744 cases were enrolled into this study, including 1344 AFNHC cases (male 1083, female 261, age 55.5 ± 12.7 years) and 400 CLD cases (male 291, female 109, age 445.0 ± 14.4 years). A logistic model with 8 variables (alpha-fetoprotein, carbohydrate antigen 19-9, alanine transaminase, alkaline phosphatase, high density lipoprotein, potassium, prothrombin time, international normalized ratio) was developed. The areas under receiver operating characteristic curve (AUCs) of the model were 0.931 in training set and 0.845 in validation set. The sensitivity, specificity and accuracy of the model in the diagnosis of AFPNHC were 81.5%, 92.7% and 84.7% in training set and 87.8%, 73.7% and 84.4% in validation set. These results showed that the model is superior to most proteins and genes as markers in the diagnosis of AFPNHC and has potential in clinical application. Conclusion: The model regressed from routine laboratory blood tests is valuable in the diagnosis of AFP negative hepatic carcinoma.