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AFP/ultrasound ameliorates surveillance of HCC

In a new study, alpha-fetoprotein measurement in combination with ultrasound improved surveillance effectiveness in patients with cirrhosis, according to published data in The American Journal of Gastroenterology.

“Surveillance of hepatocellular carcinoma in high-risk patients can improve their outcomes and is recommended by all HCC guidelines,” the researchers wrote. “Ultrasound has been the most widely accepted tool for HCC surveillance. The role of [alpha-fetoprotein] in the surveillance of HCC remains controversial.”

Researchers followed a total of 1,597 patients with cirrhosis who received HCC surveillance via ultrasound and alpha-fetoprotein (AFP) measurement at Chang Gung Memorial Hospital in Taiwan for a median duration of 4.75 years. In a retrospective analysis, the performance effectiveness of surveillance using AFP, ultrasound or both in HCC detection were all compared, according to the research.

Over the course of follow-up, 22.7% of patients (n = 363) developed HCCs. Of these patients, 58.7% (n = 213) exhibited early HCCs, according to the research. The annual incidence rate of HCC was 4.24%, with a cumulative 3-year incident rate of 7.4% and 5-year incident rate of 14.8%. The patients who developed HCC had higher AFP levels at 3, 6, 9 and 12 months before HCC developed compared with those who did not develop HCC (P < .001 for all).

For HCC detection, the area under the receiver operating characteristic curve of surveillance AFP was 0.844 (95% CI, 0.82-0.868; P < .001). Using a traditional cutoff value of 20 ng/ml, the sensitivity of AFP was 52.9% and specificity was 93.3% compared with an ultrasound sensitivity of 92.0% and specificity of 74.2%. Combined ultrasound and AFP showed a sensitivity of 99.2% and specificity of 68.3%.

By using the traditional cut-off and AFP levels increasing two times during the previous 1 year, ultrasound and AFP combined yielded a sensitivity of 99.2% and an improved specificity of 71.5%, according to the research.

“Our study suggests that until a superior alternative biomarker is developed, AFP measurement should be used in combination with [ultrasound] for HCC surveillance in patients with liver cirrhosis, in particular those with viral hepatitis-induced cirrhosis,” the researchers concluded. “The traditional cutoff value of 20 ng/ml is optimal for HCC surveillance.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.