Hepatocellular Carcinoma Surveillance: Does Alpha-Fetoprotein Have a Role?

Mehta, Ashwini; Singal, Amit G.

doi:10.1053/j.gastro.2015.07.017

Cited by 9 publications

(7 citation statements)

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“…There has been considerable debate regarding the potential benefit of adding AFP to ultrasound-based HCC surveillance programs. 8, 47, 48 It is clear the best way to address this debate would be a randomized clinical trial given inherent limitations of observation studies with indirect comparisons including biases with patient selection, flow and timing of tests, and potential confounders including the proportion of patients with obesity or advanced liver dysfunction, which are known to impact ultrasound sensitivity. However, a previously attempted randomized controlled trial comparing ultrasound alone to ultrasound with AFP was not possible given high rates of AFP contamination in the ultrasound alone study arm, highlighting providers’ reluctance to not perform AFP and rely on ultrasound alone.…”

Section: Discussionmentioning

confidence: 99%

Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis

et al. 2018

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“…Therefore, the prediction of ER of HCC requires future investigation to improve patient prognosis (3). The present study focused on patients with AFP-positive HCC to investigate the diagnostic value of ultrasonography for the recurrence of HCC (31).…”

Section: Discussionmentioning

confidence: 99%

Preoperative color Doppler ultrasonography predicts early recurrence in AFP‑positive hepatocellular carcinoma

et al. 2019

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The present study aimed to evaluate the hepatic hemodynamics of patients with α-fetoprotein (AFP)-positive hepatocellular carcinoma (HCC) and early recurrence (ER), as determined by color Doppler ultrasound. Screening with color Doppler ultrasound was performed in 150 patients with AFP-positive HCC, yielding 43 cases with postoperative ER. In addition, 35 healthy controls were enrolled in the study for comparison of the blood flow parameters between the healthy control and the HCC groups. Receiver operating characteristic curve analysis was performed to evaluate the predicted effect of Doppler for the ER of HCC. The average mean flow velocity of portal vein in patients with HCC (14.686±5.873 cm/s) was significantly lower in the HCC group compared with the healthy control group (17.631±3.569 cm/s; P=0.005). Additionally, the preoperative portal vein diameter in the HCC group was significantly higher compared with that in the healthy control group (P=0.001). Regarding the effect of surgery, the portal vein diameter was significantly increased in the patients postoperatively compared with preoperatively (P=0.003), while the pulsation and resistance indexes exhibited a decreasing trend in the postoperative group (P=0.001 and P=0.003, respectively). Notably, patients with HCC and ER presented with a higher resistance index (1.163±0.342) compared with the ER-free group (1.023±0.176; P=0.004). Furthermore, a significant difference in hepatic artery pulsation index was also observed between the ER group (0.673±0.075) and the ER-free group (0.624±0.056; P=0.018), indicating that an increased hepatic artery pulsation index may significantly predict the ER of HCC. In addition, areas under the curve of 0.683 and 0.700, respectively, suggested that the hepatic artery resistance and pulsation indexes may be used to diagnose ER in HCC (P=0.009 and P=0.004, respectively). Taken together, Doppler ultrasound provides a reliable and accurate quantification of hepatic hemodynamics for detecting ER in HCC with a good diagnostic accuracy.

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“…Although ASLD and EASL guidelines recommend using US alone to achieve this goal given concerns about the suboptimal sensitivity and specificity of AFP [2,3], and when AFP used in combination with US, its sensitivity reaches up to 63% for early-stage HCC [16].…”

Section: Alpha-fetoproteinmentioning

confidence: 99%

Diagnosis of Hepatocellular Carcinoma

Kefeli¹,

Başyiğit²,

Yeniova³

2017

Updates in Liver Cancer

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Hepatocellular carcinoma (HCC) is one of the commonest cancers worldwide, particularly in the developing countries HCC occurs predominantly in patients with underlying chronic liver disease and cirrhosis, especially due to chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. Tumors progress with local expansion, intrahepatic spread, and distant metastases, and the life expectancy of patients with HCC is poor, with a mean survival of 6-20 months. Thus, developing effective and efficient care for patients with HCC must become a significant subject. Removal of HCC by surgical, transplantation or resection of the tumors, means offers the best chance for possible cure. Criteria for such intervention have been refined over the last decade to optimize long-term survival in selected patients with Milan criteria. Not many patients are candidate given the advanced stage of their cancer at diagnosis or degree of liver disease. The other main limiting factor is inadequate organ storage. Unfortunately, many patients die when they are waiting a donor organ. Local ablative therapies may be effective for time saving as a bridge therapy, and may provide palliation, in these patients. Diagnostic tools commonly used include radiographic imaging, and rarely serum markers and liver biopsy. A suspicious lesion on the ultrasound generally requires additional imaging studies to confirm the diagnosis of the tumor. Histologic confirmation is not required in a patient at increased risk for hepatocellular carcinoma whose lesion(s) fulfill criteria for hepatocellular carcinoma which are presence of typical features, including hypervascularity during arterial phase followed by decreased enhancement (washout) during portal venous phases on computerized tomography or has increased T2 signal intensity on magnetic resonance imaging.

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Hepatocellular Carcinoma Surveillance: Does Alpha-Fetoprotein Have a Role?

Abstract: Tung S, et al. Alpha-fetoprotein measure benefits hepatocellular carcinoma surveillance in patients with cirrhosis. Am J Gastroenterol

Cited by 9 publications

References 0 publications

Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis

Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis

Preoperative color Doppler ultrasonography predicts early recurrence in AFP‑positive hepatocellular carcinoma

Diagnosis of Hepatocellular Carcinoma

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