Clinical implications of alpha-fetoprotein in liver cirrhosis: five-year follow-up study

The level of alpha-fetoprotein (AFP) was estimated by radioimmunoassay or passive hemagglutination method in a series of 159 patients with liver cirrhosis, and the incidence of serum hepatitis B antigen, histopathologic features of the liver, incidence of development of hepatocellular carcinoma (HCC) and mortality in AFP-positive cases were studied. Approximately 40 per cent of the patients had an AFP level higher than 20 ng/per ml, and all the elevations of AFP over 100 ng per ml were transient. In contrast, patients who developed HCC during the course of the disease always exhibited an increasing value of AFP. The seropositivity for AFP was significantly related to the presence of serum hepatitis B surface antigen and also to liver cell dysplasia as well as to thickening of the liver cell plates. As compared with a group of AFP-negative cases, the AFP-positive group showed a higher incidence of development of HCC and poorer prognosis over a five-year follow-up period. The data obtained suggested that increased AFP-production in patients with liver cirrhosis might reflect, largely an abnormal or altered liver cell regeneration, probably associated with hepatitis B virus, and that patients with transiently elevated AFP values might be at greater risk for the development of HCC.