Longitudinal assessment of alpha-fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis

Abstract

Background/aims: Cirrhosis is an important risk factor for hepatocellular carcinoma (HCC), and the surveillance of patients with cirrhosis is, therefore, highly recommended. However, the role of alpha-fetoprotein (AFP) in HCC surveillance is controversial. The aim of this study was to determine the role of AFP in HCC surveillance among patients with cirrhosis.

Methods: The study population consisted of 392 patients with cirrhosis. Ultrasound (US) and laboratory tests including AFP were regularly performed to detect HCC development. The cutoff level of AFP for suspicion of HCC was 7 ng/mL.

Results: During the median follow-up period of 4.7 (interquartile range, 3.4–5.6) years, HCC developed in 64 (16.3%) patients. Their mean age was 53.6 years, and they were predominantly male (63.5%). For the detection of HCCs, the sensitivity and specificity of US were 56.3% and 100%, respectively. The sensitivity and specificity of AFP were 62.5% and 94.5%, respectively. Using US and AFP in combination increased the sensitivity of surveillance to 89.1% with a specificity of 94.5%. Mean AFP levels were significantly higher in patients with than without HCC at the time of HCC diagnosis, at 6 months and 12 months before the diagnosis. The area under the receiver operating characteristic curve of AFP was highest at the time of HCC diagnosis (0.867), and also was acceptable at 6 months (0.823) and 12 months (0.792) before the diagnosis.

Conclusions: These results suggest the complementary use of AFP and US to improve the effectiveness of HCC surveillance in patients with cirrhosis.

Keywords:

• HCC
• surveillance
• ultrasound
• alpha-fetoprotein
• cirrhosis

Author contributions

Conception and design: D.Y. Kim, M.N. Kim; Acquisition, analysis and interpretation of data: M.N.xKim, B.K. Kim, S.U. Kim, J.Y. Park, K.H. Han, S.H. Ahn, D.Y. Kim; Writing, review, and/or revision of the manuscript: M.N. Kim, B.K. Kim, S.U. Kim, J.Y. Park, K.H. Han, S.H. Ahn, D.Y. Kim; Administrative, technical, or material support: M.N. Kim, D.Y. Kim; Study supervision: D.Y. Kim.

Disclosure statement

The authors disclose no conflicts.

Additional information

Funding

This study was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2015R1D1A1A01058653), and by the CHA Bundang Medical Center (grant number: BDCHA R&D 2015-25).