***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background / Aims : The aim of this study was to evaluate the feasibility of α-fetoprotein ( AFP ) as a diagnostic tool for hepatocellular carcinoma ( HCC ) in Korean patients . Methods : We retrospectively review ed the medical records of HCC and cirrhosis patients at three hospitals . For each HCC patient , a cirrhosis patient matched for age , sex , etiology , and Child-Pugh classification was selected by simple r and om sampling . The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis . Results : A total of 732 patients with HCC or cirrhosis were selected for each case and the control groups . The mean age was 54 years , and 72.4 % of patients were male . The mean serum AFP levels in the HCC group and cirrhosis group were 3,315.6 and 117.2 ng/mL , respectively ( p < 0.001 ) . The area under the receiver operating characteristic curve for all HCC patients was 0.757 . The sensitivity , specificity , and positive predictive value of AFP  was 50.55 % , 87.70 % , and 80.43 % , respectively , at a cut-off of 20 ng/mL ; 37.70 % , 95.90 % , and 90.20 % , respectively , at a cut-off of 100 ng/mL , and 30.05 % , 97.27 % , and 91.67 % , respectively , at a cut-off of 200 ng/mL. A cut-off of 100 ng/mL was more sensitive than one of 200 ng/mL with equivalent specificity and positive predictive value . Conclusions : The cut-off AFP value for early-stage HCC was 17.4 ng/mL. Our study cautiously suggests that AFP has a role in the diagnosis of HCC , and that the appropriate value of AFP for the diagnosis of HCC may be 100 ng/mL rather than 200 BACKGROUND / AIMS Alpha-fetoprotein ( AFP ) has been useful in the diagnosis of hepatocellular carcinoma ( HCC ) but lacks specificity . We assessed serum AFP among patients with chronic hepatitis C and advanced fibrosis to establish predictors of AFP elevations and changes with antiviral therapy . METHODS  Serum AFP  was measured at baseline and on therapy in patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis ( HALT-C ) . AFP levels were correlated with patient demographic and clinical features . RESULTS Baseline AFP was > or = 20 ng/mL in 191 of 1145 patients ( 16.6 % ) .  Mean AFP values were significantly higher in patients with cirrhosis than in those with bridging fibrosis ( 22.5 vs. 11.4 ng/mL , P < 0.0001 ) . Factors independently associated with raised serum AFP in patients with cirrhosis were female gender , black race , decreased platelet count , increased serum AST/ALT ratio , serum ferritin , and Mallory bodies in liver biopsies . Serum AFP levels decreased significantly during therapy with pegylated interferon alpha-2a and ribavirin .  HCC was identified in six subjects , only three of whom had AFP > 20 ng/mL. CONCLUSIONS Among patients with advanced chronic hepatitis C , serum AFP values are frequently elevated , even in the absence of HCC . Factors associated with raised AFP include severity of liver disease , female gender and black race . Serum AFP levels decline during antiviral therapy Optimum cutoff levels for plasma des-gamma-carboxy ( abnormal ) prothrombin ( DCP ) and serum alpha-fetoprotein ( AFP ) were determined by analyzing receiver operating characteristic ( ROC ) curves to discriminate between hepatocellular carcinoma ( HCC ) and benign hepatic conditions .  Plasma DCP levels  in 200 patients with HCC and 197 control patients with benign liver diseases were measured by an enzyme immunoassay with anti-DCP monoclonal antibodies , while serum AFP levels for both groups were measured by radioimmunoassay . From ROC curves and tangential lines with a slope of 1.0 , the cutoff levels of DCP and AFP were determined to be 0.11 AU/ml and 150 ng/ml , respectively . Lowered cutoff levels of DCP did not improve the sensitivity , in contrast to the increased sensitivity obtained by lowering the specificity of AFP . The sensitivities and specificities determined in this study were close to the currently used values of 0.1 AU/ml for DCP and 200 ng/ml for AFP , justifying these cutoff levels for the differentiation of benign and malignant liver diseases Mortality due to hepatocellular carcinoma ( HCC ) has not improved over the last 20 years . This is in part due to the poor performance of available tumor markers leading to delays in diagnosis . Des-gamma carboxy-prothrombin ( DCP ) has been reported to be more sensitive and specific for the diagnosis of HCC in Japanese patients compared with alpha-fetoprotein ( AFP ) . We conducted a cross-sectional case control study to evaluate whether DCP is more sensitive and specific than AFP for differentiating HCC from nonmalignant liver disease in a cohort of American patients from a single referral center . Four groups were studied : G1 , normal healthy subjects ; G2 , patients with noncirrhotic chronic hepatitis ; G3 , patients with compensated cirrhosis ; and G4 , patients with histologically proven HCC . A total of 207 subjects were enrolled . Both  DCP and AFP levels increased progressively from G1 to G4 , but DCP values had less overlap among the groups than AFP . ROC curve indicated that a DCP value of 125 mAU/mL yielded the best sensitivity ( 89 % ; 95 % CI , 77%-95 % ) and specificity ( 95 % ; 95 % CI , 82%-96 % ) for differentiating patients with HCC from those with cirrhosis and chronic hepatitis . The optimal AFP cutoff value was 11 ng/mL and was inferior to the DCP value of 125 mAU/mL , the area under the ROC curves being 0.928 versus 0.810 , respectively ( P = .002 ) . In conclusion , DCP was more sensitive and specific than AFP for differentiating HCC from nonmalignant chronic liver disease . Prospect i ve studies to evaluate the role of DCP in early HCC are underway Background : Surveillance for hepatocellular carcinoma ( HCC ) is recommended in patients with cirrhosis , but the effectiveness of a surveillance program in clinical practice has yet to be established . Aims : To evaluate the effectiveness of a surveillance program with ultrasound and alpha-fetoprotein ( AFP ) to detect early HCCs . Methods : Four hundred and forty-six patients with Child A/B cirrhosis were prospect ively enrolled between January 2004 and September 2006 and followed until July 2010 .  HCC surveillance using ultrasound and AFP was conducted per the treating hepatologist , although the st and ard was every 6 to 12 months . HCC was diagnosed using American Association for the Study of Liver Disease ( AASLD ) guidelines and early HCC defined by Barcelona Clinic Liver Cancer ( BCLC ) staging . Performance characteristics were determined for surveillance using AFP , ultrasound , or the combination . Results : After a median follow-up of 3.5 years , 41 patients developed HCCs  , of whom 30 ( 73.2 % ) had early HCCs . The annual incidence of HCC was 2.8 % , with cumulative 3- and 5-year incidence rates of 5.7 % and 9.1 % , respectively . Surveillance ultrasound and AFP had sensitivities of 44 % and 66 % and specificities of 92 % and 91 % , respectively , for the detection of HCCs . Sensitivity significantly improved to 90 % , with minimal loss in specificity ( 83 % ) when these tests were used in combination . Conclusions : When used as a surveillance program in a real-world clinical setting , combination of ultrasound and AFP is the most effective strategy to detect HCC at an early stage . Impact : Our results differ from the guidelines of the AASLD . Cancer Epidemiol Biomarkers Prev ; 21(5 ) ; 793–9 . © 2012 AACR Chronic Hepatitis B ( HB ) is the main risk factor for chronic liver disease ( CLD ) and hepatocellular carcinoma ( HCC ) in many low-re source countries , where diagnosis is constrained by lack of clinical , histopathological and biomarker re sources . We have used proteomics to detect plasma biomarkers that outperform α-Fetoprotein ( AFP ) , the most widely used biomarker for HCC diagnosis in low-re source context s. Deep-plasma proteome analysis was performed in HCC patients , patients with CLD and in HB-carrier controls from Thail and ( South-East Asia ) and The Gambia ( West-Africa ) . Mass spectrometry profiling identified latent-transforming growth factor β binding-protein 2 ( LTBP2 ) and Osteopontin ( OPN ) as being significantly elevated in HCC versus CLD and controls . These two proteins were further analyzed by ELISA in a total of 684 plasma sample s , including 183 HCC , 274 CLD and 227 asymptomatic controls . When combined , LTBP2 and OPN showed an area under the receiver operating curve of 0.85 in distinguishing HCC from CLD in subjects with AFP < 20 ng/mL. In a prospect i ve cohort of 115 CLD patients from Korea , increased plasma levels of LTBP2 and /or OPN  were detected in plasma collected over 2 years prior to diagnosis in 21 subjects who developed HCC . Thus , the combination of LTBP2 and OPN outperformed AFP for diagnosis and prediction of HCC and may therefore improve biomarker-based detection of HBV-related HCC We regret to inform you that the criticism raised by the Editorial Board is correct concerning the similarity between some parts of the texts present in our article published in Digestion [ 2011;83:83–88 ] , and the papers in the Journal of Hepatology [ 2005;43:1007–1012 ] and in Hepatology [ 2009;49:1421–1423 ] , although the research data are completely independent . We apologize for this unfortunate error , which was established during the writing process of the manuscript by the author Harun Erdal . Although the final version of the su bmi tted paper had been examined by all authors , they failed to recognize the ‘ transferred parts ’ of the papers in the Journal of Hepatology [ 2005;43:1007–1012 ] and in Hepatology [ 2009;49:1421–1423 ] . Thus , for the sake of scientific clarity and based on the above-mentioned facts , we prefer to retract our paper Diagnostic and Prognostic Validity of Golgi Protein 73 in Hepatocellular Carcinoma . Digestion 2011;83:83–88 ( DOI:10.1159/000320379 ) . Authors , Hasan Özkan Harun Erdal Hüseyin Tutkak Zihni Karaeren Mustafa Yakut Osman Yüksel Seyfettin BACKGROUND & AIMS Des-gamma-carboxy prothrombin ( DCP ) and Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein ( AFP-L3 ) are surveillance markers used to detect hepatocellular carcinoma ( HCC ) in Japan . This study evaluated their utility , alone or in combination , in a North American population . METHODS Patients with hepatitis C virus-related cirrhosis were followed up prospect ively for 2 years . RESULTS Of 372 patients , HCC developed in 34 of 298 who were free of HCC at entry . The overall sensitivity , specificity , and positive and negative predictive values for only AFP ( > 20 ng/mL ) were 61 % , 71 % , 34 % , and 88 % , respectively ; for only AFP-L3 % ( > 10 ) were 37 % , 92 % , 52 % , and 85 % , respectively ; and for only DCP ( > 7.5 ng/mL ) were 39 % , 90 % , 48 % , and 86 % , respectively . Values increased when AFP values were combined with AFP-L3 % and DCP to 77 % , 59 % , 32 % , and 91 % , respectively . Among patients with increases in AFP levels to 20 to 200 ng/mL , AFP-L3 % and DCP were highly specific markers ( 86.6 % and 90.2 % , respectively ) . Of 29 HCC patients with AFP levels less than 20 ng/mL , 13 had increased levels of AFP-L3 % or DCP . Increased alanine aminotransferase levels were associated with increased total AFP but not AFP-L3 % or DCP levels . Both AFP-L3%- and DCP-positive patients showed significant differences in lower cumulative HCC-free rates compared with the overall group ( P < .0001 and P = .0005 , respectively ) . CONCLUSIONS AFP-L3 % and DCP levels have higher correlation values with an absence of HCC , as 
    Output:
    
CONCLUSION AFP levels in serum showed good accuracy in HCC diagnosis , and the threshold of AFP with 400 ng/mL was better than that of 200 ng/mL in terms of sensitivity and specificity no matter AFP is used alone or combined with ultrasound