Routine Liver Function Blood Tests Powerfully Predict Liver Cancer Risk

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(ChemotherapyAdvisor) – Serum levels of two routinely-measured liver enzymes, alanine transaminase (ALT) and aspartate transaminase (AST), better predict hepatocellular carcinoma risk than do hepatitis-B (HBV) and hepatitis-C virus (HCV) infection, according to a prospective cohort study by US and Taiwanese researchers, published online October 16 in the Journal of the National Cancer Institute.

“These two enzymes alone predicted 91% of liver cancer cases in our prospective study,” reported senior author Xifeng Wu, MD, PhD, of the Department of Epidemiology at the University of Texas MD Anderson Cancer Center in Houston, Texas, and coauthors. “If our research is confirmed in other studies, we'd have a measure for liver cancer risk that's easy to apply via a simple blood test that's already in widespread clinical use.”

While risk prediction models are available for hepatocellular carcinoma risk among patients with chronic HBV and HCV infection, such models have not been available for other patients or the general public, the authors noted. 

Using medical data from a cohort of more than 428,500 patients of MJ Health Management, a large Asian health-screening company, the authors identified a total of 1,668 patients with hepatocellular carcinoma. Several risk-prediction models were tested, using such inputs as age, sex, HBV or HCV infection variables, and routine blood panels for liver function, the authors reported. While all of these variables were statistically significant predictors of liver cancer risk, only serum transaminase levels yielded a higher discrimination of risk than HBV or HCV infection status (Area under the curve [AUC] 0.912 [95%CI: 0.909-.915]).

Elevated ALT or AST at or above 25 IU/liter blood – well within the normal range – was indicative of elevated cancer risk, the authors reported.

“Adding HBV and HCV data to the transaminase-only model improved the discrimination (AUC 0.933 [95% CI: 0.929-0.949]),” the authors noted.

Transaminases are involved in the production of amino acids and elevated levels indicate liver damage.

Validation studies must now be conducted with non-Asian populations, the authors wrote.

Knowing personal risks of liver cancer would motivate patients to address modifiable risk factors through smoking cessation, reduced alcohol consumption, increased physical activity and improved diabetes self-management, the authors argued.

Abstract 

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