Table 9. Recommendations for future metabonomic and proteomic studies on HCC.
Key point | Recommendation |
---|---|
Use of published guidelines to inform case definitions | CLD diagnosis should be made using agreed international guidelines (e.g., EASL and AASLD). New guidelines must be developed/adapted for areas of HCC endemicity in the developing world |
Measure of total protein expression | Use commercial assays (e.g., QuantiPro BCA) to quantify and normalise total protein expression in sampled blood |
Prandial state | 8–12 h Pre-prandial |
Physical exercise | Should be avoided immediately prior to sample collection |
Overall liver function | Assessment of Child-Pugh score: A: Hepatic compensated B: Slightly decompensated liver state C: Hepatic decompensated |
Tumour size and nodularity | Tumour staging, for example, TMN classification |
Comorbidities | Clinical assessment of cirrhosis in the background of HCC Clinical assessment of renal impairment, for example, kidney function tests such as glomerular filtration rate (important for urinary analyses) |
Tumour size and nodularity | Tumour staging, for example, TMN classification |
Validation of the diagnostic model | Inclusion of external validation cohorts, for example, early HCCs, different HCC aetiologies, and tumour controls |
Performance assessment of the diagnostic model | AUROC statistic, enables direct comparison to other models and AFP |
Abbreviations: AASLD=American Association for the Study of Liver Diseases; AFP=alpha-fetoprotein; AUROC=area under receiver operating characteristics; BCA=bicinchoninic acid; CLD=chronic liver disease; EASL=European Association for the Study of the Liver; HCC=hepatocellular carcinoma; TNM=tumour, nodes, and metastasis.