Hepatocellular carcinoma (HCC) is the main pathological type of primary liver cancer (PLC) and is closely associated with Hepatitis B virus (HBV) infection. HCC in its early stages often presents no significant symptoms and is usually discovered at an advanced stage with liver, portal vein, or other site metastases, leading to a poor prognosis. Regular screening and early diagnosis in high-risk populations in the early stages of the disease are of great significance for clinical treatment and prognosis.

To explore the application value of oligosaccharides and alpha-fetoprotein (AFP) in the risk population and patients of HBV-related HCC, providing a reference for clinical diagnosis.

The study included 165 chronic HBV infection patients treated at the First Affiliated Hospital of Soochow University from January to November 2022, comprising 123 non-HCC and 42 HCC patients. Patient data (age, gender, cirrhosis status), laboratory indices[total bilirubin (TB), albumin (ALB), platelet count (PLT), AFP]were collected through electronic medical records, and a liver cancer risk prediction model score for chronic liver disease patients (aMAP score) was calculated, along with oligosaccharide marker test results (G-Test). HCC patients were classified as the HCC group (42 cases), and non-HCC patients were divided based on aMAP scores into low-risk (<50 points, 40 cases), medium-risk (50-60 points, 44 cases), and high-risk (>60 points, 39 cases) groups. Receiver operating characteristic (ROC) curves were plotted to analyze the efficacy of AFP, G-Test, and their combined diagnosis of HCC, calculating the area under the ROC curve (AUC), and the DeLong test was used to compare the differences between combined and single indicator AUCs. Kappa consistency tests were used to analyze the consistency of AFP and G-Test with clinical diagnostic results.

In patients with HCC, levels of AFP and G-Test were higher compared to those in the low-risk, medium-risk, and high-risk groups (P<0.05). Additionally, age and the proportion of liver cirrhosis were higher than those in the low-risk and medium-risk groups, ALB levels was lower than that of low risk group and medium risk group and TB levels were lower than those in the high-risk group, while PLT was lower than that in the low-risk group (P<0.05). In the high-risk group, patients exhibited higher age, TB, and G-Test levels compared to the low-risk and medium-risk groups, whereas ALB and PLT levels were lower than those in the low-risk and medium-risk groups, and the proportion of liver cirrhosis was higher than that in the low-risk group (P<0.05). Patients in the medium-risk group showed higher age and liver cirrhosis proportion compared to the low-risk group, and PLT was lower than that in the low-risk group (P<0.05). The AUCs for diagnosing HCC using AFP and G-Test were 0.796 (95%CI=0.706-0.886, P<0.001) and 0.878 (95%CI=0.813-0.943, P<0.001), respectively. The AUC for the combined diagnosis was 0.901 (95%CI=0.844-0.957, P<0.001). DeLong test results showed that the AUC for combined diagnosis was higher than AFP alone (Z=2.104, P=0.035). Consistency analysis showed that the concordance rate of AFP with clinical diagnosis was 84.8% (140/165), with moderate consistency (Kappa=0.539, P<0.001), and for G-Test, it was 89.5% (145/165), indicating higher consistency (Kappa=0.704, P<0.001). The AUC of G-Test in diagnosing AFP-negative HCC was 0.895 (95%CI=0.839-0.952, P<0.001) .

Oligosaccharide chain markers can be used as a complementary detection marker for AFP-negative HCC patients as a potential serum biomarker with better diagnostic efficacy than AFP in patients with HBV-related HCC.