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Alpha-fetoprotein in hepatic pathology and hepatocarcinoma
Insights
Alpha-fetoprotein (AFP) testing aids in detecting hepatocellular carcinoma (HCC) in patients with chronic liver disease. Monitoring AFP levels over time improves early HCC detection and risk assessment in cirrhotic patients.
Area of Science:
- Hepatology
- Oncology
- Biomarker Research
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern, often developing in patients with chronic liver diseases like cirrhosis.
- Alpha-fetoprotein (AFP) is a biomarker used in HCC screening, but its diagnostic utility requires further evaluation.
Purpose of the Study:
- To determine the frequency and significance of AFP elevation in patients with HCC and chronic hepatitis.
- To assess the role of AFP monitoring in detecting HCC development in patients with liver cirrhosis.
Main Methods:
- Examined 1099 patients with HCC and chronic hepatitis for AFP levels.
- Followed 206 cirrhotic patients from 1981-1989, monitoring for HCC development and AFP changes.
- Utilized abdominal ultrasound (US) for lesion assessment.
Main Results:
- AFP (cut-off 50 ng/ml) was positive in 67.2% of HCC patients and 12.9% with chronic hepatitis.
- Of 206 cirrhotic patients, 21 developed HCC; 71% showed increased AFP levels.
- Serological surveillance identified 71% of developing tumors, with AFP time-course showing high sensitivity and specificity for HCC risk.
Conclusions:
- AFP testing is valuable for HCC screening in chronic liver disease.
- Monitoring AFP trends is a sensitive method for early HCC detection in cirrhotic patients.
- While early detection is possible, the impact of early HCC diagnosis on patient prognosis requires further investigation.
Abstract:
We have examined a population of 1099 patients, suffering of HCC and chronic hepatitis of different nature, to determine the frequency and significance of alpha-fetoprotein elevation. Moreover we have followed up a group of 206 patients with liver cirrhosis referred to our department of hepatology in Turin, from January 1981 through April 1989. The AFP test with a cut-off of 50 ng/ml, is positive in 67.2% of tumor patients and in 12.9% of chronic hepatitis. No differences exist in patients carriers of hepatitis B virus versus alcoholic or criptogenetic subjects. Twenty-one out of 206 cirrhotic patients followed-up have developed HCC during the observation period (36.5 +/- 22.4 months). Fifteen out 21 patients (71%) showed an increase of AFP values. In 14 patients the HCC was graded as small (less than 4 cm of diameter at US) and in other 7 as advanced or multifocal. The underlying cirrhosis was alcoholic in 11 (53.3%), cryptogenic in 5 (23.8%), and hepatitis B chronic infection related in 5 (23.8%). Serological surveillance has led, to the identification of 71% of the tumors developing during this study. Using the time-course of AFP as the diagnostic parameter of the risk of HCC, we obtained the best performance in term of sensitivity, specificity and diagnostic accuracy. Screening patients at risk of HCC, using abdominal US and AFP testing, is an effective way of determinating small lesions, but how much early determination of HCC in a cirrhotic patient will improve the prognosis remain to be defined.