serum biomarkers afp, cea and ca19-9 combined detection for early diagnosis of hepatocellular carcinoma

Background: we aimed to evaluate the whether afp levels alone is an adequate screening indicator, or a combination of generally, alpha-fetoprotein (afp), ca19-9 and cea could provide a better diagnostic tool in detecting and screening asymptomatic patients with primary hepatic cancer (phc), and also evaluate the correlation of degree of differentiation with serum biomarker levels. methods: we retrospectively reviewed the medical records of 1362 patients form 2014-2018 who visited the first affiliated hospital of zhejiang university, hangzhou, china for health check-ups or were diagnosed with cancer or cirrhosis. we then analyzed preoperative tumor markers level of afp, ca19-9, and cea. the standard reference values (afp ≤20 ng/l cea ≤ 5 ng/l, and ca19-9 ≤ 37 u/ml) were as positive or negative cut off values. further, the histological sections of patients were categorized and correlated them with the three serum biomarkers. results: serum afp, cea, and ca19-9 levels in the phc group were significantly higher compared to those with liver cirrhosis and healthy control groups (p < 0.03). with afp as a single tumor marker for phc diag-nosis, it had a sensitivity of 63.3% with a specificity of 80.8%. afp combined with ca19-9 and cea showed specificity of 100%, a sensitivity 2.5% with the positive and negative predictive values of 100% and 22% re-spectively. furthermore, histological evaluation revealed the highest afp level of 9366.14±23902.61 ng/l associated with poorly differentiated hcc, while well-differentiated hcc, had the lowest mean afp level of 45.19±181.27 ng/l. conclusion: combined serum levels of afp, ca19-9 and cea does not provide a superior advantage over afp alone as a screening and diagnostic tool for hcc detection.