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. 2021 Apr 15;2021(4):CD013346. doi: 10.1002/14651858.CD013346.pub2

Park 2017b.

Study characteristics
Patient Sampling The study was aimed to investigate the role of AFP for HCC in patients with advanced liver cirrhosis waiting for liver transplantation. During 10 years, 2074 adult liver‐surgery recipients were identified. They were divided into two groups as HCC and non‐HCC.
Age range not reported. Males 71%.
Patient characteristics and setting  
Index tests AFP: ROC curve analysis showed that AUC of AFP was 0,693 having a cut‐off at 6,8 ng/mL with sensitivity of 64.5% and specificity of 64.5%.
Target condition and reference standard(s) HCC: all patients underwent orthotopic liver transplantation (OLT).
Flow and timing No information on interval between index test and reference standard
Comparative  
Notes No information on conflicts of interest
Methodological quality
Item Authors' judgement Risk of bias Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled? No    
Was a case‐control design avoided? Yes    
Did the study avoid inappropriate exclusions? Unclear    
Could the selection of patients have introduced bias?   High risk  
Are there concerns that the included patients and setting do not match the review question?     High
DOMAIN 2: Index Test (AFP)
Were the index test results interpreted without knowledge of the results of the reference standard? Yes    
If a threshold was used, was it pre‐specified? No    
Could the conduct or interpretation of the index test have introduced bias?   High risk  
Are there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern
DOMAIN 2: Index Test (US+AFP)
DOMAIN 2: Index Test (US)
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition? Yes    
Were the reference standard results interpreted without knowledge of the results of the index tests? Unclear    
Could the reference standard, its conduct, or its interpretation have introduced bias?   Unclear risk  
Are there concerns that the target condition as defined by the reference standard does not match the question?     High
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard? Unclear    
Did all patients receive the same reference standard? Yes    
Were all patients included in the analysis? Yes    
Could the patient flow have introduced bias?   Unclear risk