Racial disparities in alpha‐fetoprotein testing and alpha‐fetoprotein status associated with the diagnosis and outcome of hepatocellular carcinoma patients

Autor: Xiaolei Shi, Yitao Ding, Jing Wu, Bo Liu, Yuan Guo, Zhicheng Yao, Guoyi Wu, Xiaoben Pan
Jazyk: angličtina
Rok vydání: 2019
Předmět:
0301 basic medicine
Male
Cancer Research
alpha‐fetoprotein
diagnosis
Logistic regression
Gastroenterology
0302 clinical medicine
Epidemiology
Medicine
Early Detection of Cancer
Original Research
Liver Neoplasms
digestive
oral
and skin physiology
hepatocellular carcinoma
Middle Aged
Prognosis
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Up-Regulation
Gene Expression Regulation
Neoplastic
Survival Rate
Oncology
030220 oncology & carcinogenesis
Hepatocellular carcinoma
Cohort
racial disparities
embryonic structures
surveillance
Female
epidemiology
alpha-Fetoproteins
Alpha-fetoprotein
End results
Adult
medicine.medical_specialty
Carcinoma
Hepatocellular
end results
overall survival
lcsh:RC254-282
03 medical and health sciences
Young Adult
Internal medicine
Overall survival
Humans
Radiology
Nuclear Medicine and imaging
neoplasms
Aged
business.industry
Proportional hazards model
Clinical Cancer Research
medicine.disease
United States
digestive system diseases
030104 developmental biology
Logistic Models
business
SEER Program
Zdroj: Cancer Medicine, Vol 8, Iss 15, Pp 6614-6623 (2019)
Cancer Medicine
ISSN: 2045-7634
Popis: Background The use of alpha‐fetoprotein (AFP) testing for the surveillance, diagnosis, and prognosis of hepatocellular carcinoma (HCC) remains controversial. Here, we compared AFP testing rates, elevated AFP rates, factors associated with elevated AFP levels, and prognostic factors associated with overall survival (OS) in HCC patients from different ethnic groups. Methods Patients with HCC were identified from the Surveillance, Epidemiology, and End Results registries. Race was categorized as white, black, and others. AFP testing rates and elevated AFP rates were analyzed. Multivariable logistic regression and Cox regression analyses were used to identify independent factors associated with elevated AFP levels and prognosis, respectively. All statistical tests were two sided. Results A proportion of 79.2% of total HCC patients had AFP testing reports; 77.3% of white, 79.7% of black, and 81.2% of other races underwent AFP testing. Compared with white and other races, black HCC patients had a higher rate of elevated AFP levels among all patients and the early‐stage HCC patient cohort. Elevated AFP level was a significant prognostic factor for all HCC patients in different race groups. Factors associated with elevated AFP level and prognostic factors associated with OS varied significantly by race. Conclusions AFP testing, elevated AFP rates, predictors of elevated AFP level, and prognostic factors associated with OS differed significantly according to race after adjusting for AFP levels among the three groups. AFP testing for the surveillance, diagnosis, and prognosis of HCC patients is strongly recommended, although racial disparities need to be considered.
We hypothesized that the racial disparities of the elevated AFP in HCC patients may be an important issue regarding to the difference of using AFP for HCC surveillance and diagnosis between Asian and the United States HCC patients. Our results showed that elevated AFP rates were high in all three race groups, and the highest rate of AFP tests performed and elevated was the black race group, which was reported to be the least likely to present with an elevated AFP at diagnosis. Our present findings suggest that AFP testing could still be considered for the diagnosis, and prognosis of HCC patients with more attention to the black race.
Databáze: OpenAIRE
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