title: Alpha-fetoprotein has no prognostic role in small hepatocellular carcinoma identified during surveillance in compensated cirrhosis.
abstract: Alpha-fetoprotein is a tumor marker that has been used for surveillance and diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. The prognostic capability of this marker in patients with HCC has not been clearly defined. In this study our aim was to evaluate the prognostic usefulness of serum alpha-fetoprotein in patients with well-compensated cirrhosis, optimal performance status, and small HCC identified during periodic surveillance ultrasound who were treated with curative intent. Among the 3,027 patients included in the Italian Liver Cancer study group database, we selected 205 Child-Pugh class A and Eastern Cooperative Group Performance Status 0 patients with cirrhosis with a single HCC ≤ 3 cm of diameter diagnosed during surveillance who were treated with curative intent (hepatic resection, liver transplantation, percutaneous ethanol injection, radiofrequency thermal ablation). Patients were subdivided according to alpha-fetoprotein serum levels (i.e., normal ≤ 20 ng/mL; mildly elevated 21-200 ng/mL; markedly elevated >200 ng/mL). Patient survival, as assessed by the Kaplan-Meier method, was not significantly different among the three alpha-fetoprotein classes (P = 0.493). The same result was obtained in the subgroup of patients with a single HCC ≤ 2 cm (P = 0.714). An alpha-fetoprotein serum level of 100 ng/mL identified by receiver operating characteristic curve had inadequate accuracy (area under the curve = 0.536, 95% confidence interval = 0.465-0.606) to discriminate between survivors and deceased patients.
  
  
  CONCLUSIONS
  Alpha-fetoprotein serum levels have no prognostic meaning in well-compensated cirrhosis patients with single, small HCC treated with curative intent.
authors.affiliation: Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, Italy. egiannini@unige.it
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.forename: Simona
authors.initials: S
authors.lastname: Marenco
authors.forename: Giacomo
authors.initials: G
authors.lastname: Borgonovo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.forename: Gian Ludovico
authors.initials: GL
authors.lastname: Rapaccini
authors.forename: Maria
authors.initials: M
authors.lastname: Anna Di Nolfo
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Maria
authors.initials: M
authors.lastname: Chiaramonte
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins