title: Value of alpha-foetoprotein for screening of recurrence in hepatocellular carcinoma post resection.
abstract: BACKGROUND
  The aim of this study was to establish the value of alpha-foetoprotein (AFP) for the screening of recurrences in hepatocellular carcinoma (HCC) in patients who have undergone curative hepatic resection.
  
  
  METHODS
  72 HCC patients who had curative resection/liver transplant in 2000-2006 were monitored for recurrence by evaluating the three- or six-monthly AFP and computed tomography images. Patients without recurrence were followed up for a mean duration of 7.27 years.
  
  
  RESULTS
  Out of the 72 patients, 34 (47.2%) suffered from HCC recurrence. 65.4% of recurrent cases had AFP values showing an upward trend. Patients with recurrence had higher AFP values than those without at last follow-up (119.45 μg/L vs. 3.1 μg/L, p < 0.001). AFP at recurrence was independent of gender, race, history of alcohol consumption and hepatitis C or cirrhosis status. Patient with hepatitis B or those with tumours larger than 5 cm had higher AFP values. The best cut-off AFP indicative of HCC recurrence was 5.45 μg/L (sensitivity 84.4%; specificity 77.1%). High preoperative AFP was associated with high AFP at recurrence (correlation coefficient 0.553, p = 0.01).
  
  
  CONCLUSIONS
  AFP alone is an inadequate screening test for HCC recurrence since only about two-thirds of patients showed upward AFP trend on recurrence. Our study found a relatively low cut-off point for detection of recurrence (5.54 μg/L). Patients with high preoperative AFP tended to have high AFP on recurrence. Imaging is recommended for patients with AFP levels > 5.45 μg/L, especially when AFP shows a rising trend.
authors.affiliation: Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, 1E Kent Ridge Road, Singapore. cfscky@nus.edu.sg
authors.forename: S K
authors.initials: SK
authors.lastname: Chang
authors.forename: W W
authors.initials: WW
authors.lastname: Hlaing
authors.forename: R Q
authors.initials: RQ
authors.lastname: Yu
authors.forename: T W
authors.initials: TW
authors.lastname: Lee
authors.forename: I S
authors.initials: IS
authors.lastname: Ganpathi
authors.forename: K K
authors.initials: KK
authors.lastname: Madhavan
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000097:blood* / Q000601:surgery; D008297:Male; D008495:Medical Oncology / Q000379:methods; D015233:Models, Statistical; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D000509:alpha-Fetoproteins / Q000096:biosynthesis*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins