Signification of Serum Alpha-Fetoprotein Levels in Cases of Compensated Cirrhosis and Hepatitis C Virus without Hepatocellular Carcinoma

Abstract

AFP (alpha-fetoprotein) levels are increased during the development of HCC (hepatocellular carcinoma); nonetheless, it can also be produced by non-tumoral hepatocytes in conditions of high cell turnover. Our study aims to provide additional data regarding the causes of elevated AFP in patients with liver cirrhosis due to hepatitis C virus (HCV) infection. We conducted an observational prospective cohort study that included 2068 patients with compensated cirrhosis and chronic hepatitis C genotype 1b infection. The two main inclusion criteria were the presence of advanced liver fibrosis - Metavir stage F4 - diagnosed by FibroMax testing, Fibroscan or liver biopsy, and the presence of detectable HCV RNA in the serum. Plasmatic AFP levels were determined through the electrochemiluminescence method, with a standard value ranging from 0 to 7 ng/ml. All data were obtained from the Romanian National Health Agency. The average AFP serum levels in patients with compensated cirrhosis without HCC were 9.4 ng/ml (range 0.5 � 406 ng/ml); 30.1% of patients had significantly increased levels of AFP (>15 ng/ml). High values of serum AFP in patients with compensated liver cirrhosis without HCC was correlated with more advanced age (p<0.001), severe necroinflammatory activity detected by FibroMax (p<0.001), severe NASH (p<0.001), severe steatosis (p<0.001), low platelets (p<0.001), increased values of AST and ALT (p<0.001).

Clinical profiles and risk factors of hepatocellular carcinoma with viral hepatitis at a tertiary hospital in Mogadishu

“…We also observed a significant difference in the distribution of AST and ALT by viral infection status, and this could be due to acute/chronic (53,54), despite its contested role (55). It may not be an indispensable diagnostic or screening tool (56); however, our study showed that serum AFP levels were markedly elevated. Similarly, GGT has also been proposed as a potential marker for the early detection of HCC.…”

“…AFP is a biomarker whose serum concentration rises in most patients with HCC; consequently, it has been utilised in the monitoring and diagnosis of or early detection of neoplasms in HCC (53,54), despite its contested role (55). It may not be an indispensable diagnostic or screening tool (56); however, our study showed that serum AFP levels were markedly elevated. Similarly, GGT has also been proposed as a potential marker for the early detection of HCC.…”

“…HCC is frequently diagnosed in patients with pre-existing liver cirrhosis, but it can also develop without such a condition. Liver cirrhosis and high serum ALT are two factors that may influence serum AFP elevation (56). Although we did not test liver cirrhosis in our study, we did not find a clear correlation between AFP and ALT.…”

“…Although we did not test liver cirrhosis in our study, we did not find a clear correlation between AFP and ALT. The interaction between ALT levels and HCC onset and development has influences serum AFP levels (56). However, nearly all the HCC patients with elevated AFP presented elevated GGT levels simultaneously.…”

Cholangiocellular carcinoma occurrence after HCV eradication therapy: case series and review of the literature

“…In the last five years, the treatment of HCV infection has greatly advanced with the introduction of new, more efficient agents named direct-acting antivirals (DAAs) [ 2 ]. These drugs target several nonstructural proteins of the virus that disrupt replication and stop the infection.…”