Alpha-fetoprotein for Diagnosis, Prognosis, and Transplant Selection

Abstract

Reliable biomarkers are of great clinical value in predicting cancer occurrence/recurrence, anticipating its detection at an asymptomatic stage, supporting the radiological diagnosis, stratifying patients for prognosis and proper therapy, and measuring the response to treatment. Despite the plethora of biomarkers proposed for hepatocellular carcinoma (HCC), the first one identified, α-fetoprotein (AFP), remains the most utilized. This article reviews the lights and shadows of AFP as a surveillance test for patients at risk of HCC, and as a diagnostic test for those with chronic liver disease and a suspected hepatic mass. Moreover, the article scrutinizes the large body of evidence supporting the prognostic relevance of AFP in patients undergoing both curative and palliative treatment of HCC and the growing importance attributed to this biomarker (as a static or a dynamic variable) in the selection of potential candidates for liver transplantation. In fact, the inclusion of AFP among transplant criteria would improve the ability of identifying poor candidates due to an unacceptable risk of HCC recurrence regardless of tumor burden, and of adopting flexible morphological selection criteria.

Combination of inflammatory score/liver function and AFP improves the diagnostic accuracy of HBV‐related hepatocellular carcinoma

“…Serum AFP, however, is sometimes not entirely trustworthy, because AFP is often below the diagnostic value in some early‐stage or even a few late‐stage HCC cases . In contrast, AFP is elevated substantially in some patients with chronic hepatitis B (CHB), liver cirrhosis, and benign hepatic tumor diseases . Thus, AFP is a biomarker for reference only in the early diagnosis HCC without other supporting clinical information.…”

On the Electrochemical Detection of Alpha-Fetoprotein Using Aptamers: DNA Isothermal Amplification Strategies to Improve the Performance of Weak Aptamers

“…This is the case of alpha-fetoprotein (AFP), one of the two biomarkers suitable for large-scale screening in addition to the controversial prostate specific antigen [1]. AFP serum levels rapidly decrease after birth and remain below 10 ng mL −1 under healthy conditions except in pregnant women [2,3]. Since the expression of AFP is highly specific for the liver, it was found elevated in hepatocellular carcinoma (HCC) patients and proposed as a tumor biomarker.…”

“…However, AFP alone is not enough for HCC diagnosis, screening or surveillance [4]. Its suboptimal performance, that is, increased levels in benign liver pathologies and teratomas or low levels in small HCC [5], has prompted that US and European guidelines allow HCC surveillance with or without AFP control, in contrast to Asian guidelines that recommend its use in combination with imaging techniques or even other biomarkers [2]. Nonetheless, it remains as a supplemental test when only low-quality or inconclusive images are available.…”

RNA sequencing of plasma exosomes revealed novel functional long noncoding RNAs in hepatocellular carcinoma

“…Clinically, AFP is the most widely used serum biomarker for HCC diagnosis. However, the diagnostic sensitivity of AFP is partially impacted by AFP− HCC 48 . Our study found that lnc85 was significantly increased in both AFP+ and AFP− HCC, and it distinguished AFP− HCC from HC and LC.…”