Consecutive Increment of Serum AFP Level Is a Useful Surrogate Marker in Predicting HCC in Liver Cirrhosis Patients = Consecutive Increment of Serum AFP Level Is a Useful Surrogate Marker in Predicting HCC in Liver Cirrhosis Patients

다국어 초록 (Multilingual Abstract)

Aims: The role of alpha-feto protein (AFP) in the diagnosis of hepatocellular carcinoma (HCC) is getting smaller due to the advances of imaging modalities. However, consecutive increment of AFP level in liver cirrhosis patients is presumed to be associated with the higher risk of developing HCC in clinical settings. Such a notion instigated us to analyze serial AFP levels of HCC patients in a retrospective manner.
Methods: From January 2002 to December 2016, 2259 patients were diagnosed with HCC in Seoul St. Mary’s hospital. Among them 236 cirrhotic patients were found to have a serial record of AFP measurements for over one year. We assessed AFP levels at the time the diagnosis of HCC was made and compared them with that of patients at 3,6 and 12 months prior to the diagnosis.
Results: At the time the diagnosis was made, the patients’ baseline characteristics were as follows; mean age was 58.89 years (32-87), median tumor size was 2.1cm (0.7-26.3), median AFP level was 20.35 ng/mL (0.75-32134). Median AFP level of 12 months, 6 months and 3 months before the diagnosis of HCC was 6.26 ng/mL (0.6-513), 8.73 ng/mL (0.66-1287.86), 12.95 ng/mL (0.91-1461), respectively. We divided patients by two groups; one was AFP over 20 ng/mL at the time of diagnosis of HCC, and the other one was not. In elevated AFP group (n=119), median AFP level of 12 months, 6 months and 3 months before the diagnosis of HCC and at the time of the diagnosis of HCC was 12.79 ng/mL (0.81-513), 24.58 ng/ mL (1.25-1287.86), 43.41 ng/mL (2.54-1461), 278.03 ng/mL (11.8-19017), respectively. In non-elevated AFP group (n=115), median AFP level of 12 months, 6 months and 3 months before the diagnosis of HCC and at the time of the diagnosis of HCC was 4.54 ng/mL (0.6-74.78), 4.68 ng/mL (0.66-91), 5.04 ng/mL (0.91-17.9), 4.99 ng/mL (0.75-18.29), respectively. Repeated-measure ANOVA was used to analyze the significance of increase in consecutive AFP levels in HCC surveillance. In elevated AFP group, Consecutive increment of AFP level was statistically significant in time dependent manner (P≤0.000) with linear relationship (P≤0.000). There was no significant change of consecutive AFP level In non-elevated AFP group. Consequentially, there was significant difference of AFP level between the two groups in time dependently (P≤0.000).
Conclusions: Early detection of HCC with relatively smaller sizes was possible due to the close observation of increase in serial AFP levels. We suggest increase in serial AFP level as a strong surrogate marker in the prediction of HCC and that those with consecutive increments of AFP levels for more than 2 times should be candidates for active surveillances for HCC.