Alpha-Fetoprotein in the 1990s

Taketa, Kazuhisa

doi:10.1007/978-1-4612-0401-5_3

Cited by 5 publications

(3 citation statements)

References 60 publications

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“…With values of that magnitude, the specificity of AFP is close to 100% but at a cost to the sensitivity which falls below 45% [40]. In a study using 20 ng/ml as the cut-off point, the sensitivity rose to 78.9%, although the specificity declined to 78.1% [41]. The positive predictive value (PPV) of AFP is low, ranging from 9% to 32% [42].…”

Section: Screening Testsmentioning

confidence: 96%

Diagnosis of hepatocellular carcinoma

Bialecki

Bisceglie

2005

HPB

281

223

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Hepatocellular carcinoma (HCC) is responsible for a large proportion of cancer deaths worldwide. HCC is frequently diagnosed after the development of clinical deterioration at which time survival is measured in months. Long-term survival requires detection of small tumors, often present in asymptomatic individuals, which may be more amenable to invasive therapeutic options. Surveillance of high-risk individuals for HCC is commonly performed using the serum marker alfafetoprotein (AFP) often in combination with ultrasonography. Various other serologic markers are currently being tested to help improve surveillance accuracy. Diagnosis of HCC often requires more sophisticated imaging modalities such as CT scan and MRI, which have multiphasic contrast enhancement capabilities. Serum AFP used alone can be helpful if levels are markedly elevated, which occurs in fewer than half of cases at time of diagnosis. Confirmation by liver biopsy can be performed under circumstances when the diagnosis of HCC remains unclear.

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Section: Screening Testsmentioning

confidence: 96%

Diagnosis of hepatocellular carcinoma

Bialecki

Bisceglie

2005

HPB

281

223

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“…AFP has been reported to be higher in patients with HCC arising from chronic viral conditions compared to those with alcoholic liver disease (146 ) and in younger (147 ) and male (147 ) patients. In one cohort study of 239 patients with chronic hepatitis, 277 with cirrhosis, and 95 with HCC, AFP gave sensitivities for HCC of 79% and 52.6% at decision points of 20 g/L and 200 g/L, respectively, with corresponding specificities of 78% and 99.6% (148 ). According to some Japanese investigators (149 ), any circulating AFP value Ͼ10 g/L in patients with chronic liver disease should be regarded as suspicious of HCC and prompt further investigation, e.g., using AFP-L3 (LCA) or AFP-P4 (E-PHA) lectin tests and imaging.…”

Section: Afp In Diagnosismentioning

confidence: 99%

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric Cancers

et al. 2010

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Background: Updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for the use of tumor markers in the clinic have been developed. Methods: Published reports relevant to use of tumor markers for 4 cancer sites—liver, bladder, cervical, and gastric—were critically reviewed. Results: α-Fetoprotein (AFP) may be used in conjunction with abdominal ultrasound for early detection of hepatocellular carcinoma (HCC) in patients with chronic hepatitis or cirrhosis associated with hepatitis B or C virus infection. AFP concentrations >200 μg/L in cirrhotic patients with typical hypervascular lesions >2 cm in size are consistent with HCC. After a diagnosis of HCC, posttreatment monitoring with AFP is recommended as an adjunct to imaging, especially in the absence of measurable disease. Although several urine markers have been proposed for bladder cancer, none at present can replace routine cystoscopy and cytology in the management of patients with this malignancy. Some may, however, be used as complementary adjuncts to direct more effective use of clinical procedures. Although carcinoembryonic antigen and CA 19-9 have been proposed for use gastric cancer and squamous cell carcinoma antigen for use in cervical cancer, none of these markers can currently be recommended for routine clinical use. Conclusions: Implementation of these recommendations should encourage optimal use of tumor markers for patients with liver, bladder, cervical, or gastric cancers.

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“…CT or MRI imaging along with elevated AFP levels was indicative of AFP-secreting HCC. 20 For tumors not associated with AFP, histological evidence with a minimum of one measurable lesion was required.…”

Section: Patient Selectionmentioning

confidence: 99%

Use of Yttriurn-90 TheraSphere for the Treatment of Unresectable Hepatocellular Carcinoma

Liu

Uaje

Al-Ghazi

et al. 2004

The American Surgeon

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This is a retrospective analysis of a new treatment modality, intra-arterial administration of Yttrium-90 TheraSphere, for unresectable hepatocellular carcinoma (HCC). Patients with HCC not amenable to surgical treatment who had satisfactory physiological function without comorbid disease or significant pulmonary shunting were eligible for treatment. Patients were categorized into complete, partial, or no response based on serum alpha-fetoprotein (AFP) levels and CT or MRI imaging. Fourteen patients were considered candidates for treatment. Three patients were excluded due to significant hepatopulmonary shunting. Eleven patients were treated with TheraSphere. One patient (9%) had a complete response, eight patients (78%) had a partial response, and two patients (18%) showed no response. Partial and complete responders with AFP-associated HCC demonstrated a median decrease in AFP levels of 79 per cent at 73 days. No patients developed liver toxicity nor died due to treatment. Five patients (45%) died of progressive disease at a median of 7 months post-treatment. Six patients (54%) were alive at a median of 11 months (range, 9 to 20 months). Okuda stage 2 and 3 patients showed a median survival of 11 months and 7 months, respectively. Yttrium-90 TheraSphere treatment for unresectable hepatocellular carcinoma is well tolerated and appears to extend survival.

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Alpha-Fetoprotein in the 1990s

Cited by 5 publications

References 60 publications

Diagnosis of hepatocellular carcinoma

Diagnosis of hepatocellular carcinoma

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric Cancers

Use of Yttriurn-90 TheraSphere for the Treatment of Unresectable Hepatocellular Carcinoma

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