HCC with low- and normal-serum alpha-fetoprotein levels

Area of Science:

• Hepatology
• Oncology
• Biomarker Discovery

Background:

• Alpha-fetoprotein (AFP) is a commonly used biomarker for hepatocellular carcinoma (HCC).
• However, a significant proportion of HCC patients present with low or normal AFP levels, complicating diagnosis and monitoring.
• Understanding the characteristics of these low-AFP HCCs is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the clinical and pathological features of HCC patients with varying AFP levels.
• To identify factors associated with tumor growth and progression in low-AFP HCC.
• To evaluate the need for novel biomarkers beyond AFP in HCC management.

Main Methods:

• Retrospective analysis of a large cohort of 1773 HCC patients in Turkey.
• Stratification of patients based on AFP levels (<20, 20-100, 100-1000, >1000 IU/ml).
• Statistical analysis including linear regression to identify significant variables related to tumor characteristics (e.g., tumor size, multifocality, portal vein thrombosis).

Main Results:

• Over 58% of HCC patients had AFP levels below 100 IU/ml.
• Low-AFP HCCs were more common in smaller tumors (<5 cm) compared to larger ones (>5 cm).
• Tumor size and portal vein thrombosis (PVT) were significantly associated with platelet count and PVT presence in low-AFP HCC. PVT increased across AFP level groups, with tumor size also increasing.
• Low- or normal-AFP HCCs exhibited lower tumor size and significantly lower PVT compared to elevated AFP HCCs.

Conclusions:

• Low or normal AFP levels are prevalent in HCC patients, particularly those with smaller tumors.
• Tumor growth and progression in low-AFP HCC are influenced by factors beyond AFP, including platelet count and PVT.
• The findings highlight the urgent need for developing new, non-AFP biomarkers for the accurate diagnosis and management of HCC, especially in patients with low or normal AFP levels.