Elevations in serum alpha-fetoprotein levels in patients with chronic hepatitis B

In a retrospective analysis of 166 patients with chronic hepatitis B followed for up to 8 years, 22 patients had 29 episodes of elevations in serum alpha-fetoprotein (AFP) levels. Twenty-five episodes were due to a transient exacerbation of the underlying hepatitis and 11 of these episodes were followed by a loss of hepatitis B e antigen (HBeAg) from serum and a remission in disease. Two patients were found to have hepatocellular carcinoma. No apparent cause could be found in a further two episodes of AFP elevation. In comparison to 144 patients with normal levels, the 22 with AFP elevations were more likely to have cirrhosis (61% versus 13%, P = 0.01), to die a liver-related death (27% versus 0.7%, P = 0.0007) and to have hepatocellular carcinoma (HCC) (9% versus 0%, P = 0.002). These findings confirm that AFP can be used to screen for HCC in high-risk patients with chronic hepatitis B. The majority of AFP elevations, however, will be found to be due to exacerbations of disease, with or without loss of HBeAg from serum, especially in white patients with severe disease and cirrhosis.