title: Low alpha-fetoprotein hepatocellular carcinoma.
abstract: OBJECTIVE
  A large proportion of hepatocellular carcinoma (HCC) patients do not secrete elevated levels of the tumor marker alpha-fetoprotein (AFP). There is little published guide to prognostic features of this patient subset.
  
  
  METHODS
  We interrogated a large HCC database in which all patients had been followed until death, to examine which features might be prognostically useful.
  
  
  RESULTS
  We found 413 biopsy-proven unresectable HCC patients with low serum AFP values. Serum gamma glutamyl transpeptidase (GGTP) levels were one of the most significant factors for survival. This dichotomization into low and high GGTP levels separated the patients into distinctive survival ranges. Patients with GGTP levels < 110 U/100 mL and small tumors had longest survival > 795 days. Patients with GGTP > or = 110 U/mL and large tumors with the presence of portal vein thrombosis had the shortest survival range of 300-560 days.
  
  
  CONCLUSIONS
  Serum levels of the onco-fetal protein GGTP represent a useful prognostic parameter in HCC patients with low AFP levels.
authors.affiliation: Liver Tumor Program of Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. brian.carr@jefferson.edu
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
authors.forename: Petr
authors.initials: P
authors.lastname: Pancoska
authors.forename: Robert A
authors.initials: RA
authors.lastname: Branch
mesh_terms: D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology; D019992:Databases as Topic; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D010414:Pennsylvania; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000032:analysis*; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins; D005723:gamma-Glutamyltransferase