Serum alpha-foetoprotein in hepatocellular carcinoma--value in diagnosis, and prognosis

The value of serum alpha-foetoprotein (AFP) estimation using radioimmunoassay in patients with hepatocellular carcinoma (HCC) has been investigated. Serum AFP concentration was raised in 97% of patients with cirrhosis complicated by tumour, while only one of 100 patients with uncomplicated cirrhosis had increased concentrations. Serial serum AFP estimation was therefore a valuable screening test in this high-risk group. Raised serum AFP was found to be an additional adverse prognostic factor in HCC patients: 81% of a group of HCC patients with normal serum AFP survived one year while only 12% of patients with raised AFP levels did so. However, this mainly reflects underlying cirrhosis in those HCC patients with raised AFP. Serum AFP doubling time was determined in 28 HCC patients with raised serum AFP and showed a significant correlation with survival, those slowest doubling times surviving longest. Serial AFP determinations were useful in predicting the outcome of chemotherapy: an exponential rise in AFP occurred in those who failed to respond to treatment, but serum AFP fell in those who achieved clinical remission, with a sustained fall in those with complete remission.