Should AFP (or Any Biomarkers) Be Used for HCC Surveillance?

Abstract

a) Purpose of review To address the controversy around the use of biomarkers for hepatocellular carcinoma (HCC) surveillance in individuals with cirrhosis or chronic hepatitis B who are at risk for development of liver cancer. b) Recent findings Recent studies suggest that surveillance for hepatocellular carcinoma is beneficial, even after adjustment for lead time and other biases. Alpha fetoprotein (AFP) is complementary to ultrasound (US) in surveillance, particularly in obese patients and patients with infiltrative tumors. US and AFP are both associated with harms to patients from false positive over-diagnosis, with US appearing to cause greater harms. Including patient demographic characteristics and additional biomarkers into diagnostic models is beneficial. Recent studies emphasize the advantage of time trends in biomarkers over single cross-sectional measurements. c) Summary AFP and other biomarkers are complementary to US in surveillance for HCC, especially when applied in models including patient variables and incorporating time trends in biomarker levels. With advances in genetic and molecular analysis of tumors, we may be poised at the cusp of a revolution in HCC surveillance.

Sequential Circulating Tumor Cell Counts in Patients with Locally Advanced or Metastatic Hepatocellular Carcinoma: Monitoring the Treatment Response

“…Although serum AFP levels are routinely used in the clinical setting to monitor the disease status of patients with HCC, the serum AFP levels are found in the normal range for up to 42% of patients with HCC [25]. The use of serum AFP levels for HCC surveillance is not recommended by the American Association for the Study of Liver Diseases due to the lack of specificity [26]. Image examinations such as CT or MRI are still the standards for monitoring the treatment response.…”

Management of hepatitis B virus infection, updated Swedish guidelines

“…Additional serum alpha-fetoprotein (AFP) analysis should be considered [29]. Particularly an increasing value over time warrants further investigation [30].…”

Serum sphingolipids predict de novo hepatocellular carcinoma in hepatitis C cirrhotic patients with sustained virologic response

“…However, de novo HCCs occur in 2%‐8% despite SVR, especially in male cirrhotic patients . To date, alpha‐fetoprotein (AFP), a serum glycoprotein, is the only widely used diagnostic biomarker in HCC surveillance . Nonetheless, Farinati et al observed an unsatisfactory sensitivity of AFP, especially in the detection of early‐stage HCC; almost 50% of HCC patients were AFP‐negative (AFP level below 20 ng/mL).…”

“…9,10 To date, alpha-fetoprotein (AFP), a serum glycoprotein, is the only widely used diagnostic biomarker in HCC surveillance. 11 Nonetheless, Farinati et al observed an unsatisfactory sensitivity of AFP, especially in the detection of early-stage HCC 12 ; almost 50% of HCC patients were AFP-negative (AFP level below 20 ng/mL). Therefore, to ameliorate early HCC detection and improve efficacy of screening strategies new HCC biomarkers are required.…”