Prospective study of α-fetoprotein in cirrhotic patients monitored for development of hepatocellular carcinoma

Abstract

The usefulness of measurements of serum alpha-fetoprotein elevation for diagnosis of the development of hepatocellular carcinoma was evaluated by a prospective study of 260 patients with cirrhosis. Hepatocellular carcinoma was found in 55 patients during the 5-yr follow-up, excluding 7 found to have hepatocellular carcinoma in the first 6 mo. The cumulative incidence of hepatocellular carcinoma was 26% in the 185 patients who had alpha-fetoprotein levels below 20 ng/ml at the time of entry and 46% in the 68 patients who had alpha-fetoprotein levels of 20 ng/ml or more but below 200 ng/ml. In 169 of the patients, serum levels of alpha-fetoprotein were assayed regularly for at least 2 yr. The incidence of hepatocellular carcinoma development in the 36 patients who had repeated transient increases in alpha-fetoprotein to above 100 ng/ml was 36%. This was significantly higher than the incidence in the 99 patients who had alpha-fetoprotein levels consistently below 20 ng/ml. Thus patients who had alpha-fetoprotein levels of 20 ng/ml or more, who had transient increases in alpha-fetoprotein or who had both should be treated as being in a super-high-risk group for hepatocellular carcinoma. Frequent and careful examination by ultrasonography of such patients is recommended.

758 Frequency of Elevated Biomarkers in Patients With Cryptogenic Hepatocellular Carcinoma

“…Few early-stage HCC-nonBC cases present with abnormal AFP serum levels. Several reports have shown elevated AFP to be a risk factor for HCC development in HCV and/or HBV patients [24,[30][31][32][33][34][35][36]. However, our results suggest AFP alone to be insufficient for HCC-nonBC surveillance.…”

Outcome of hypovascular hepatic nodules revealing no gadoxetic acid uptake in patients with chronic liver disease

“…Some large cohort studies have shown that hepatitis B and C virus infections and liver cirrhosis play important roles in the pathogenesis of HCC (23)(24)(25)(26). Every year, 3-6% of prospectively evaluated patients with hepatitis C virus-related cirrhosis develop HCC (23,27). However, the annual rate of HCC occurrence was only 0.4% in their study population, which included a small proportion of cirrhotic patients (28).…”

Screening for hepatocellular carcinoma

“…The annual risk of developing HCC in cirrhosis is between 1% and 6%. [14][15][16][23][24][25][26][27][28][29] Although several studies have shown that the risk of HCC is higher in patients with cirrhosis caused by viral infection compared with nonviral causes, 14,16,28,29 a high rate of HCC has also been reported in patients with cirrhosis caused by genetic hemochromatosis. 30 In contrast, low incidence rates are seen in biliary cirrhosis.…”

“…This was the marker used in the first reported surveillance studies of HCC. 29,44,45 The sensitivity of AFP for detecting HCC varies widely in both HBV-positive and predominantly HBV-negative populations, 22,25,27,28,44,46,47 possibly because of the confusion between diagnosis and screening. If the level of AFP triggering investigation for HCC is increased, e.g., from 20 mg/L to 100 mg/L, 25 the sensitivity of the AFP test falls from 39% to 13%, while the specificity increases.…”

“…47 Performance characteristics of AFP as a screening test were reported in three studies. 22,25,27 In these studies, the screening methodology was well described, and it was clear that AFP was used for surveillance. These studies report a sensitivity of 39% to 64%, a specificity of 76% to 91%, and a positive predictive value of 9% to 32%.…”