Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 48 2 2019 02 01 314 322 Muhammad Ibrahim Alhadi EDOO Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China AND Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, China Vikram Kumar Chutturghoon Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China AND Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, China Gyabaah Kwabena WUSU-ANSAH Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China AND Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, China Hai ZHU Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China AND Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, China Tao Yang ZHEN Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China AND Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, China Hai Yang XIE Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, China Shu-Sen ZHENG Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China AND Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, China 2019 02 05 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 diagnosis, 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% respectively. 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.   https://ijph.tums.ac.ir/index.php/ijph/article/view/16153 https://ijph.tums.ac.ir/index.php/ijph/article/download/16153/6289