title: Effectiveness of α-fetoprotein for hepatocellular carcinoma surveillance: the return of the living-dead?
abstract: The evaluated article assesses the effectiveness in clinical practice of surveillance with ultrasound (US) and α-fetoprotein (AFP) in patients at risk of developing hepatocellular carcinoma. After a median follow-up of 3.5 years, among the 442 enrolled patients with cirrhosis, 41 developed tumor (annual incidence, 2.8%). Twenty-three hepatocellular carcinomas were diagnosed at Barcelona Clinic Liver Cancer early stage (single tumor <5 cm or ≤3 tumors each <3 cm). Two hundred and seventy one patients (61.3%) underwent 'consistent' (US done at least annually) surveillance, whereas 107 (24.2%) and 64 (14.5%) patients underwent 'inconsistent' and 'no surveillance', respectively. The per-patient sensitivity was 43.9% for US (58.1% excluding cases where US was inconsistently performed) and 65.9% for AFP >20 ng/ml. Specificity was 91.5% for US and 90.5% for AFP. The combination of the tests increased the sensitivity to 90.2%, with a small decrease in specificity (83.3%). In a real-world setting, the combination of US and AFP would be the most effective for hepatocellular carcinoma surveillance.
authors.affiliation: Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, Genova, Italy.
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.forename: Virginia
authors.initials: V
authors.lastname: Erroi
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani