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Are the 5-hydroxymethylcytosine-based wd-scores really superior over α-fetoprotein for the early diagnosis of hepatocellular carcinoma?
  1. Yongpeng Chen,
  2. Xiao-Yu Lin
  1. Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
  1. Correspondence to Dr Yongpeng Chen, Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; cyp{at}

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We read with interest the recent article by Cai et al 1 describing the development of 5-hydroxymethylcytosine (5hmC)-based wd-scores that have better accuracy in diagnosing early hepatocellular carcinoma (HCC) than does α-fetoprotein (AFP). Although several gene signatures have been published but not used in practice of early HCC diagnosis,2 this study showed the potential application of the 5hmC-based wd scores. However, several concerns remain that need to be clarified.

First, the wd-scores’ cut-off for early diagnosis of HCC, derived by the maximal Youden index and characterised by a sensitivity of 82.7% and a specificity of 76.4%, is suboptimal; this would result in missed diagnosis of early HCC in 17.3% of patients, and the corresponding …

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  • Contributors Both authors have contributed significantly to the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.