Normal Alpha-fetoprotein Values Research Articles

Characterization of hepatocellular carcinoma in Mexico

Introduction and aimsIn Mexico, complications of cirrhosis are the third leading cause of death in adult males. In recent decades, the incidence of hepatocellular carcinoma has increased worldwide. The aim of this study was to determine the characteristics of patients with hepatocellular carcinoma at two Mexican tertiary care hospitals. Material and methodsAn observational, cross-sectional, retrospective study was conducted between January 2008 and April 2014. We described the clinical features, epidemiologic characteristics, diagnosis, and treatment of patients with hepatocellular carcinoma. ResultsOne hundred and forty-eight patients were included. There was a predominance in males and disease manifestation in the sixth decade of life. Liver disease was associated in 87% of subjects and was mainly attributed to alcohol abuse, hepatitis C infection, and nonalcoholic steatohepatitis. Sixty percent (60%) of cases were classified as Child-Pugh stage A cirrhosis, 75.5% harbored a single tumor at diagnosis, 27.7% had normal alpha-fetoprotein values, and only 39.2% of patients with known liver disease were under a surveillance program. Tumors were larger than 5cm at diagnosis in 64.3% of patients, and well-differentiated lesions were most frequently detected. Over 70% of patients were diagnosed at a non-curative stage. By the 2014 study cutoff point, 77.7% of patients had died. Treatment was determined by the means available at each center and followed the therapeutic recommendations in international guidelines in 45.3% of cases, clearly impacting survival. ConclusionsBetter surveillance methods are required to diagnose the disease at its early stages, but treatment still requires individual adaptation to each center's available resources.

Predicting clinical outcomes in patients with HBsAg-positive chronic hepatitis.

The progression of HBsAg-positive chronic hepatitis is insidious and unpredictable. Identification of factors leading to either a benign or more serious clinical outcome may assist in decision making for antiviral therapy. From 1989 to 1998, 130 untreated patients with chronic hepatitis were enrolled in a prospective study and followed every 3-6 months with liver and virologic tests, platelet counts and alpha-fetoprotein (AFP) measurements. During a mean follow-up of 107 ± 86 months, 16 (12.3 %) chronic hepatitis patients progressed to cirrhosis (annual rate 1.4 %), and 23 (17.7 %) reverted to being inactive carriers (annual rate 2.1 %). Compared to baseline values, chronic hepatitis patients who progressed to cirrhosis exhibited declines in mean platelet counts (225.7-195.2 mm(3), p = 0.008-0.04) during the first 4 years of follow-up, while those who reverted to being inactive carriers had substantial reductions in mean levels of AST (83.5-27.2 u/l, p < 0.001-0.002) and ALT (100.2-29.2 u/l, p < 0.001-0.007). In addition, during spontaneous alanine aminotransferase (ALT) flares, patients progressing to cirrhosis had concomitant elevations of AFP levels, while patients who became inactive carriers maintained normal AFP values during ALT flares (13.45 vs. 4.65 ng/ml, p = 0.001). These AFP differences during episodes of ALT flares were similarly observed when analyzed in two separate cohorts of cirrhosis and inactive carrier patients. Patients with chronic hepatitis who progressed to cirrhosis exhibited declines in platelet counts and had AFP elevations during ALT flares. To prevent progression, serial measurements of these parameters during the chronic hepatitis stage will assist in identifying patients requiring antiviral therapy.

TRANSFORMING GROWTH FACTOR β1 AND SOLUBLE FAS SERUM LEVELS IN HEPATOCELLULAR CARCINOMA

In this study we assessed the usefulness of serum Transforming Growth Factor-β1 (TGF-β1) and soluble Fas (sFas) in distinguishing liver cirrhosis (LC) with and without hepatocellular carcinoma (HCC) as compared with alpha-fetoprotein (AFP). Serum TGF-β1 and sFas levels were measured by ELISA in 51 LC patients, 54 patients with HCC and 30 healthy donors. Considering as a cut-off limit (mean+1SD of controls) 74pg/ml and 637pg/ml for TGF-β1 and sFas, respectively, we computed serum concentrations of TGF-β1 and sFas as a score (mean±SD). The positive frequency of serum TGF-β1 levels in HCC patients (54%) was greater than in LC patients (26%) and healthy donors (3%). TGF-β1 levels were higher in HCC (1.6±0.5) than in LC (1.1±0.2) (P<0.0001) and healthy donors (0.6±0.2). Using a cut-off limit of 82pg/ml (mean+2SD), the positive frequency of TGF-β1 was 20% in HCC patients. None of the controls and LC patients had TGF-β1 levels higher than 82pg/ml. The positive frequency of serum sFas levels was 100% in HCC patients, 98% in LC patients and 3% in healthy controls. Serum sFas levels were higher in HCC (2.5±0.7) than in LC (1.9±0.5) (P<0.001) and healthy donors (0.6±0.3). No significant change of positive frequency was obtained by setting sFas cut-off at higher levels. sFas values did not correlate with TGF-β1 levels. No relationship was found between TGF-β1 amounts and AFP levels. However, in the 23% of HCC patients, with normal AFP values TGF-β1 levels were higher than the cut off. These findings suggest the potential usefulness for TGF-β1 assay in AFP-negative HCC.

PRENATAL DIAGNOSIS OF NEURAL-TUBE DEFECTS WITH A MONOCLONAL ANTIBODY SPECIFIC FOR ACETYLCHOLINESTERASE

An immunoassay for acetylcholinesterase (AChE), based on a monoclonal antibody (AE-2), gave the following results when applied to a panel of amniotic fluids: (a) among 651 samples with normal outcome and normal alphafetoprotein (AFP) values there were 2 (0·31 Wa) false positives; (b) of 9 samples with normal outcome and raised AFP values 1 had a raised AChE titre; (c) all 48 samples from anencephaly cases had raised AChE values; (d) among 49 samples from open spina bifida cases (2 of which had normal AFP values), 48 had raised AChE titres. It is suggested that a monoclonal-antibody-based immunoassay may displace polyacrylamide gel electrophoretic analysis of AChE as a complementary test to AFP in prenatal diagnosis of neural-tube defects, since it is a quantitative test largely independent of operator skill and experience.

The significance of alpha-feto-protein (AFP) and human chorionic gonadotrophin (HCG) during the first half of pregnancy (author's transl)

The determination of AFP and HCG was used as a diagnostic parameter for the functional integrity of the feto-placental unit during the first 20 weeks of normal and disturbed pregnancies. In contrast to HCG which can already be detected very shortly after nidation and reaches a maximum between the 10th and 12th week of gestation, AFP does not begin to rise discernibly before the 8th and 9th week and attains the highest values in the third trimester. The assay of AFP did not contribute relevant data when carried out before the 10th week of pregnancy. Contrary to that, an irreversibly damaged pregnancy has to be expected when lower than normal AFP values are found after the 10th week, even in the presence of a normal level of HCG. Likewise, higher than normal values should be taken as a reliable sign of embryonal demise after the 14th week of pregnancy, as long as a multiple gestation, a previous amniocentesis or a neural tube defect can be excluded. Serum AFP did not only increase markedly in many cases after interruption of pregnancy, but even after amniocentesis or premature rupture of the amniotic sac when fetal cells having a high content of AFP enter the maternal circulation.

Amniotic fluid alphafetoprotein measurements in the early prenatal diagnosis of central nervous system disorders.

Amniotic fluid alphafetoprotein (AFP) has been measured in 520 pregnancies between 8 and 24 weeks of gestation. The normal range of values has been defined for fortnightly periods between these limits. Grossly elevated AFP concentrations were found in four pregnancies leading to spina bifida and nine pregnancies leading to anencephaly. Slightly elevated AFP concentrations were found in one twin pregnancy and two pregnancies affected by rhesus isoimmunisation. Normal AFP values were observed in 36 amniotic fluids from pregnancies where the outcome was rhesus isoimmunisation, an inborn error of metabolism, a cytogenetic disorder or a birth defect unrelated to the central nervous system. The reliability of amniotic fluid AFP in the early prenatal diagnosis of spina bifida and anencephaly and the possibility of performing assays on samples sent by post from any part of the world are emphasized.