Prospective study of α‐fetoprotein in cirrhotic patients monitored for development of hepatocellular carcinoma

• Published in: Hepatology (Baltimore, Md.) Md.), 1994-01, Vol.19 (1), p.61-66
• Main Authors: Oka, Hiroko, Tamori, Akihiro, Kuroki, Tetsuo, Kobayashi, Kenzo, Yamamoto, Sukeo
• Format: Article
• Language: English
• Subjects: alpha-Fetoproteins - analysis; Biological and medical sciences; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - etiology; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Incidence; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Neoplasms - diagnosis; Liver Neoplasms - epidemiology; Liver Neoplasms - etiology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Predictive Value of Tests; Prognosis; Prospective Studies; Risk; Sensitivity and Specificity
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.1840190111

The usefulness of measurements of serum α‐fetoprotein elevation for diagnosis of the development of hepatocellular carcinoma was evaluated by a prospective study of 260 patients with cirrhosis. Hepatocellular carcinoma was found in 55 patients during the 5‐yr follow‐up, excluding 7 found to have hepatocellular carcinoma in the first 6 mo. The cumulative incidence of hepatocellular carcinoma was 26 in the 185 patients who had α‐fetoprotein levels below 20 ng/ml at the time of entry and 46 in the 68 patients who had α‐fetoprotein levels of 20 ng/ml or more but below 200 ng/ml. In 169 of the patients, serum levels of α‐fetoprotein were assayed regularly for at least 2 yr. The incidence of hepatocellular carcinoma development in the 36 patients who had repeated transient increases in α‐fetoprotein to above 100 ng/ml was 36. This was significantly higher than the incidence in the 99 patients who had α‐fetoprotein levels consistently below 20 ng/ml. Thus patients who had α‐fetoprotein levels of 20 ng/ml or more, who had transient increases in α‐fetoprotein or who had both should be treated as being in a super‐high‐risk group for hepatocellular carcinoma. Frequent and careful examination by ultrasonography of such patients is recommended. (Hepatology 1994;19:61–66).