TITLE:
Alpha-fetoprotein testing for hepatocellular carcinoma may not be helpful in nonalcoholic steatohepatitis
AUTHORS:
Linda L. Wong, Christopher J. Kim, Sandi A. Kwee, Brenda Y. Hernandez
KEYWORDS:
Hepatocellular Cancer; Nonalcoholic Steatohepatitis; Alpha-Fetoprotein
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.3 No.1,
February
28,
2013
ABSTRACT:
Background
& Objectives: Diagnosing hepatocellular carcinoma (HCC) often utilizes serum
tumor markers. Although the most commonly used tumor marker in clinical practice,
alpha-fetoprotein (AFP) is not included in recent guidelines for diagnosing HCC.
The overall performance characteristics of AFP as a tumor marker is viewed as insufficiently
sensitive or specific. The diagnostic value of AFP specifically in nonalcoholic
steatohepatitis (NASH) related HCC is unknown. We aimed to determine the utility
of AFP testing in NASH-related HCC. Methods: Retrospective review of 737 HCC patients
referred from 1993- 2011 to a single facility
treating the majority of chronic liver
disease in Hawaii. HCC was diagnosed histologically by percutaneous biopsy,
liver biopsy at the time of surgery, or examination of the resected liver. Patients
were classified according to HCC risk factors including NASH, hepatitis B and C
infection, and alcohol-related. Other data collected
included: demographics, ethnicity, presence
of cirrhosis, tumor characteristics (size, number, vascular invasion), diabetes,
hyperlipidemia, body mass index (BMI) and blood testing to calculate Model for End-Stage
Liver Disease (MELD) score. Elevated AFP was defined as >20 ng/mL. Sensitivity
of AFP was determined and compared between various subgroups. Results: Elevated
AFP levels were detected in 64.3% of patients. AFP sensitivity was 47% for NASH-related
HCC (n = 100), and 67.2% for HCC with viral or alcoholic risk factors (n = 637)
(OR 0.43, 95% CI 0.28 - 0.66, p = 0.0001). Elevated AFP had higher sensitivity in
females (71.9% vs. 61.8%, OR 1.58, 95% CI 1.1 - 2.27, p = 0.013), non-diabetics
(67.4% vs. 57.2%, OR 0.65, 95% CI 0.47 - 0.89, p = 0.0093), and cirrhotics (67.1%
vs. 56.8%, OR 1.55, 95% CI 1.10 - 2.19, p = 0.0012).AFP did not vary significantly with regard to hyperlipidemia or BMI. AFP was more sensitive in advanced
disease including tumors > 5 cm, multiple tumors, or vascular invasion (all with
p