Decreasing Trend of Serum α-Fetoprotein Level in Hepatocellular Carcinoma

Serum α-fetoprotein (AFP), a well-established biomarker for hepatocellular carcinoma (HCC), increases the sensitivity of ultrasound-based surveillance programs for early stage HCC detection.^1,2 Multiple factors, including tumor burden, can affect AFP levels in patients with HCC.³ Nontumoral factors, such as race/ethnicity and liver disease etiology, are also known to be associated with elevated AFP.³ With the increasing trend of earlier stage HCC detection and shift from viral to nonviral etiology, we hypothesized that AFP level at HCC diagnosis would decrease in the United States.