Clinical Significance of Elevated Alpha-Fetoprotein (AFP) in Patients with Chronic Hepatitis C, but not Hepatocellular Carcinoma

Hu, Ke–Qin; Kyulo, Namgyal L.; Lim, Nelson; Elhazin, B.; Hillebrand, Donald J.; Bock, Tracy

doi:10.1111/j.1572-0241.2004.04152.x

Cited by 157 publications

(147 citation statements)

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“…Alpha-fetoprotein (AFP) is the most commonly used marker for the diagnosis of HCC. An elevated serum level of AFP is known to be associated with HCC but it is also elevated in some cases of chronic hepatitis and cirrhosis [17]. Thus, it has poor sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Clinical utility of prothrombin induced by vitamin K absence in the detection of hepatocellular carcinoma in Indian population

et al. 2010

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Background Alpha-fetoprotein (AFP) is a well known widely used biomarker for the detection of hepatocellular carcinoma (HCC); however, it suffers from a low sensitivity and specificity. Protein or prothrombin induced by vitamin K absence or antagonist II (PIVKA-II) is another tumor marker elevated in HCC but not extensively used. Aim Evaluation of PIVKA-II and AFP in diagnosing HCC in India. Patients and methods The study group consisted of 70 consecutive HCC patients, 38 patients with cirrhosis, 30 patients with chronic hepatitis, and 30 normal healthy subjects. All patients were evaluated for PIVKA-II and AFP levels by ELISA. Result The mean plasma concentration of PIVKA-II in HCC, cirrhotic, chronic hepatitis patients and healthy controls was 101.07 ± 78.30 ng/ml, 2.45 ± 4.25 ng/ml, 1.50 ± 0.98 ng/ml and 0.79 ± 0.75 ng/ml, respectively. Receiver operating characteristic (ROC) curve was plotted for PIVKA-II and AFP. At a cutoff level of 9.2 ng/ml for PIVKA-II a sensitivity of 80% and a specificity of 92.1% was found, whereas AFP at a cutoff level of 13.02 ng/ml showed 72.9% sensitivity and 65.8% specificity. No significant relationship of plasma levels of PIVKA-II was observed in HCC with HBsAg/antiHCV positivity and associated portal vein thrombosis, but a positive correlation was seen with the tumor size (P = 0.001). However, no such significant association was found with AFP. Conclusion PIVKA-II was more sensitive and specific than AFP for diagnosing HCC in the Indian population.

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Section: Introductionmentioning

confidence: 99%

Clinical utility of prothrombin induced by vitamin K absence in the detection of hepatocellular carcinoma in Indian population

et al. 2010

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“…In the patients with high pre-treatment AFP level, the change in AFP level was significant at the 6th month of the therapy. The reported prevalence of elevated AFP in patients with chronic hepatitis C varied from 10% to 43% [16,17,22,23]. The pathogenesis and clinical significance of the mild elevated AFP remain to be defined, although some studies have demonstrated that elevation of serum AFP is associated with increased transaminase, severe fibrosis, genotype 1b, and cirrhosis [16-18, 23, 24].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of hepatocellular carcinoma is generally made in patients with a mass lesion in a cirrhotic liver if the AFP is over 400 ng/ml [14][15]. However, some patients have an elevated AFP, but no evidence of hepatocellular carcinoma that could be found after a thorough radiologic evaluation [16][17][18]. Several reports have demonstrated a decrease in the elevated AFP after interferon-α therapy in patients with chronic hepatitis C without a mass lesion in the liver [19][20][21].…”

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confidence: 99%

Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C

Senol¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Alfa-feto protein (AFP) hepatosellüler karsinom tanısı için yaygın olarak kullanılan bir belirteçtir. Bazı hepatit C'li hastalar, yüksek AFP değerle-ri sergilemekte ancak hepatosellüler karsinom kanıtı bulundurmamaktadır-lar. Bu çalışmanın amacı, hepatosellüler karsinomu bulunmayan kronik hepatit C'li hastalarda serum AFP üzerinde antiviral tedavinin etkisini değerlen-dirmektir. Gereç ve Yöntem: Kronik hepatit C'li otuz yedi hasta (20 kadın ve 17 erkek) bu çalışmaya dahil edildi. Tüm hastalara pegile veya konvansiyonel IFN ve ribavirin kombinasyon tedavisi verildi. Serum AFP bazal değerde ve tedavinin 3-6-12. aylarında ölçüldü. Bulgular: ALT düzeyinin tedavi öncesi ile karşılaştırıldığında (88,59 ± 57.22 IU) 3,6 ve 12. aylardaki düzeyleri istatistiksel olarak daha düşüktü (p< 0.001). Ortalama serum AFP düzeyleri yavaş yavaş tedavi öncesindeki 6,6 ± 6,05 ng/ml düzeyinden sırasıyla 3. ayda 5,1 ± 3,7 (p>0,05), 6. ayda 4,34 ± 4,64 (p>0,05) ve 12. ayda 2,63 ± 2,17 (p<0,001) düzeylerine indi. AFP düzeyi yüksek olan hastalarda (>10 ng/ml) 3. ayda istatistiksel olarak anlamlı olmayan düşme gözlenirken; 6. ve 12. aylarda istatistiksel olarak anlamlı oranda düşüş gözlendi. Bu hastalarda ortalama serum AFP düzeyleri 3, 6 ve 12. aylarda sırasıyla 11, 39±3,30, 6,97±2,53 (p<0,001) ve 5,67±3,89 (p=0,009)'dı ve tedavi öncesi değer olan 15,09 ± 5,92 ng/ml'e göre düşüktü. Tartışma: Serum AFP düzeyi 48 hafta boyunca interferon-α ve ribavirin alan hepatit C'li hastalarda tedavi sırasında anlamlı derecede azalmaktadır. Anahtar KelimelerKronik Hepatit C; Alfa-Fetoprotein; İnterferon Alfa; Ribavirin Abstract Aim: Alpha-fetoprotein (AFP) has been widely used as a diagnostic marker for hepatocellular carcinoma. Some patients with hepatitis C show high AFP values, but no evidence of hepatocellular carcinoma. The aim of this study is to assess the influence of antiviral treatment on the serum AFP in patients with chronic hepatitis C without hepatocellular carcinoma. Material and Method: Thirty seven chronic hepatitis C patients (20 females and 17 males) were included in the study. All patients were given a combined treatment of pegylated or conventional interferon (IFN) and ribavirin. Serum AFP was measured at baseline and on months 3-6-12 of the therapy. Results: Compared to the pretreatment levels of ALT (88,59 ± 57,22 IU), those at 3, 6 and 12 months were statistically lower (p< 0,001). Mean serum AFP levels gradually decreased from pretreatment level of 6,6 ± 6,05 ng/ml to 5,1 ± 3,7 (p>0,05), to 4,34 ± 4,64 (p>0,05) and to 2,63 ± 2,17 (p<0,001) at month 3, 6 and 12 of the therapy, respectively. Although AFP decrease at month 3 was non significant, a significant decrease of mean serum AFP levels after 6 and 12 months of therapy was demonstrated in the patients with high AFP (>10 ng/ml). In these patients, mean serum AFP levels were decreased from pretreatment level of 15,09 ± 5,92 ng/ml to 11,39±3,30, to 6,97±2,53 (p<0,001) and to 5,67±3,89 (p=0,009) at month 3, 6 and 12, respectively. Discussion: Serum AFP level signific...

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“…15 The trends of the AFP levels in the subjects of our study are unknown, but based on the UNOS guidelines, all of these patients would have had recertification at 3-month intervals, and all must have demonstrated an ongoing rise in AFP in order to maintain their MELD exception points. In another study, Hu et al 16 retrospectively analyzed chronic hepatitis C patients with a median follow-up period of 24 months and reported that none of the patients with persistently elevated or fluctuating AFP developed HCC. Similarly, a recent report from the HALT-C trial highlighted the poor correlation between AFP and the presence of HCC.…”

Section: Discussionmentioning

confidence: 99%

An analysis of the UNOS liver transplant registry: High serum alpha-fetoprotein does not justify an increase in MELD points for suspected hepatocellular carcinoma

et al. 2006

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The current United Network for Organ Sharing (UNOS) criteria for liver transplantation gives priority to patients with elevated serum alpha-fetoprotein (AFP; Ն 500 ng/mL) in the absence of radiologic evidence of a hepatic mass. Reports have shown that an elevated serum AFP is a poor diagnostic indicator for hepatocellular carcinoma (HCC) in patients with cirrhosis. Our aim was to determine if an AFP level above 500 ng/mL, in the absence of a liver mass by imaging study, correlates with the presence of HCC. Using the UNOS database we identified all patients transplanted for HCC in the United States between February 2002 and October 2005 based on these criteria. The data collected included: patient demographics, clinical information, and pathological outcomes. The data was analyzed using a chi-squared t-test and confirmed by logistic regression modeling. A total of 22 patients received a cadaveric liver transplant, while 1 received a living donor transplant during the study period. HCC was confirmed posttransplantation in only 6 patients (26%). There was no difference in race, gender, etiology of liver disease, or AFP level between patients with and without HCC but a significant difference in age (59.8 yr for HCC patients vs. 51.3 yr for the non-HCC group; P ϭ 0.01). In conclusion, the majority of the patients who received extra Model for End-Stage Liver Disease (MELD) points based on an elevated AFP did not have HCC. Older age was a significant predictor for the presence of HCC in patients with a serum AFP greater than 500 ng/mL. These results demonstrate the poor correlation of serum AFP with the presence of HCC in patients awaiting liver transplantation. Liver Transpl 12: 1519-1522, 2006.

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Clinical Significance of Elevated Alpha-Fetoprotein (AFP) in Patients with Chronic Hepatitis C, but not Hepatocellular Carcinoma

Abstract: In patients with chronic hepatitis C, 23.0% had elevated serum AFP that is independently associated with stage III/IV hepatic fibrosis, elevated level of AST, and prolonged INR.

Cited by 157 publications

References 24 publications

Clinical utility of prothrombin induced by vitamin K absence in the detection of hepatocellular carcinoma in Indian population

Clinical utility of prothrombin induced by vitamin K absence in the detection of hepatocellular carcinoma in Indian population

Serial Changes in Alpha-Fetoprotein Levels During Therapy for Chronic Hepatitis C

An analysis of the UNOS liver transplant registry: High serum alpha-fetoprotein does not justify an increase in MELD points for suspected hepatocellular carcinoma

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