Serum gammaglutamyl transpeptidase, alkaline phosphatase, and alfa-fetoprotein in small HCCs.

Abstract

e14528 Background: We previously analyzed a large cohort of unresectable HCC patients, ordered by survival. Significant new prognostic factors included gamma glutamyltranspeptidase (GGTP) and alkaline phosphatase (ALKP), as well as previously-described alfa-fetoprotein (AFP). We wished to extend this approach to analysis of small tumors, which could have significance for screening, given AFP limitations. Methods: A further 557 patients with small HCCs who were diagnosed by screening, were analyzed for baseline serum GGTP, ALKP and AFP and ordered by tumor mass (size x number) and tumor number (one or > one). Results: 355 patients (pts) had tumor mass <3 (small) and 202 pts had mass >3 (larger). Small vs. larger tumors with GGTP >45 IU/l were 42% vs. 64%, AFP >25 ng/ml were 32% vs. 43%, ALKP >120 IU/l were 19% vs. 30%. Liver function was excellent, with total bilirubin being <1.3 mg/dl in 88% of each group and albumin being >3g/dl 96% of small and 95% of larger tumors. Thus, GGTP was elevated in 50% more pts than AFP in each group. The cohort was then analyzed according to presence of a single (73% of total) or more than one tumor. For 1 vs. >1 tumor, results were: elevated GGTP 46% vs. 59%, elevated AFP 37% vs. 41%, elevated ALKP 16% vs. 22%. Total bilirubin and albumin levels were similarly normal. For tumor mass <3, 100% of pts had a single tumor; for tumor mass >3, 25% pts had a single tumor and 75% had >1. Age was remarkable as at <65 yrs (61% of pts) all pts had only a single tumor with <3 tumor mass at <3cm diameter. For pts >65 yr (39% of pts) there was a steady increase in tumor size and # with age. Conclusions: For pts with small tumors and normal bilirubin who were diagnosed by radiological screening, there was a much higher % with elevated serum GGTP than AFP.