[Clinical significance of transiently elevated serum AFP level in developing hepatocellular carcinoma in HBsAg positive-liver cirrhosis].
OBJECTIVE
Serum alpha fetoprotein (alpha-FP) measurement has a limitation to detect hepatocellular carcinoma (HCC) because it is elevated in various liver diseases. Therefore, we studied the sensitivity and specificity of high alpha-FP in the diagnosis of HCC.


METHODS
We studied 253 patients with HBsAg positive liver cirrhosis prospectively. We analyzed incidence of HCC related cut-off values of serum alpha-FP levels. During the follow-up period, we analyzed sensitivity and specificity of cut-off values of alpha-FP for the diagnosis of HCC, and alpha-FP elevation rate in relation to mass size.


RESULTS
One hundred and twenty-five patients had a transient elevation of alpha-FP levels above 20 ng/mL. The corresponding incidences of HCC were 27.2% (34/125) and 15.6% (20/128 patients without elevation of alpha-FP), respectively with a statistically significant difference (p=0.03). Among 54 patients with HCC, 18 patients (33.0%) had levels of alpha-FP below 20 ng/mL on the time of diagnosis of HCC. When we defined cut-off values of serum alpha-FP as 20, 100 and 500 ng/mL, the corresponding sensitivity and specificity for HCC were 62.9% and 24.0%, 7.4% and 54.2%, 77.3% and 91.9%, respectively. We studied sensitivity according to cut-off values of alpha-FP defined as 20, 100, 200, 500 ng/mL in patients with small HCC below 2 cm. The corresponding sensitivity were 50.0%, 43.7%, 25.0%, 18.7%, respectively. In patients with levels of serum alpha-FP below 20 ng/mL, percentages of mass size less than 2 cm, 2~3 cm, 3~5 cm and more than 5 cm were 50.0%, 25.0%, 28.5% and 25.0%, respectively.


CONCLUSIONS
We suggested that in order to detect HCC, careful periodic monitoring with alpha-FP, ultrasonography and abdominal computed tomography is needed in patients with HBsAg positive liver cirrhosis and whose serum level of alpha-FP is above 20 ng/mL.
Lee
Heon Young
HY
Department of Internal Medicine, Chungnam National University College of Medicine, 640 Daesa-dong, Jung-gu, Daejeon 301-721, Korea. leehy@hanbat.chungnam.ac.kr
Jung
Jae Hoon
JH
Kang
Yoon Sae
YS
Kim
Yeon Soo
YS
Moon
Hee Seok
HS
Park
Ki Oh
KO
Lee
Yeum Seok
YS
Kim
Seon Mun
SM
Seo
Seung Won
SW
Lee
Sang Woo
SW
Kim
Seok Hyun
SH
Lee
Byung Seok
BS
Kim
Nam Jae
NJ
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000032:analysis*
D014408:Biomarkers, Tumor; D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins