Abstract
BackgroundAlpha-fetoprotein (AFP) is a biomarker for hepatocellular carcinoma (HCC). The significance of pre-treatment AFP (pt-AFP) in non-viral HCC (nvHCC) is not clear.MethodsPatients with nvHCC, referred to a Hepatobiliary Clinic from September 2011–2015 were screened. HCC was diagnosed using American Association for the Study of Liver Disease guidelines, and TNM staged. nvHCC was diagnosed when HBsAg and anti-HCVAb was negative. Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores were calculated. AFP level was evaluated against patient characteristics, tumour characteristics and survival.ResultsThree hundred eighty-nine patients with nvHCC [age 64(12–88) years; 344(88.4%) males] were screened. Median AFP was 25.46 ng/ml (1.16–100,000). 41.2% (n = 160) Of patients had normal AFP level. 22.9% (n = 89) had AFP over 400 ng/ml. Female gender (P < 0.05), vascular invasion (P < 0.001), tumours over 5 cm (P < 0.05), late TNM stage (P < 0.001) and non-surgical candidates had higher AFP levels. Diffuse type (P < 0.001), macro vascular invasion (P < 0.001) and late stage tumours (P < 0.001) had AFP over 400 ng/ml. Having AFP below 400 ng/ml was associated with longer survival (16 vs. 7 months, P < 0.001).ConclusionPre treatment AFP has a limited value In diagnosing nvHCC, Having a AFP value over 400 ng/ml was associated with aggressive tumour behaviour and poor prognosis.
Highlights
Alpha-fetoprotein (AFP) is a biomarker for hepatocellular carcinoma (HCC)
Half of all cases of HCC are associated with hepatitis B virus infection and 25% associate with hepatitis C virus [2]
In Sri Lanka, great majority of patients with HCC are not associated with viral aetiology [5] in keeping with the low prevalence of Hepatitis B
Summary
Alpha-fetoprotein (AFP) is a biomarker for hepatocellular carcinoma (HCC). The significance of pre-treatment AFP (pt-AFP) in non-viral HCC (nvHCC) is not clear. In absence of viral aetiology other factors such as alcoholic liver disease, non - alcoholic steato - hepatitis (NASH), intake of aflatoxin contaminated food, diabetes, and obesity [3, 4] are secondary risk factors. Serum alpha-fetoprotein (AFP) is a commonly used screening biomarker in patients at risk for HCC. Use of AFP in diagnosing HCC has been debated due to its variability in sensitivity and specificity [11]. It has been recognized as a poor prognostic factor in patients with HCC. There is paucity of data on the significance of pre treatment alpha–fetoprotein in HCC patients of non-viral aetiology.
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