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α‐fetoprotein monitoring in chinese patients with chronic hepatitis B virus infection: Role in the early detection of hepatocellular carcinoma
Author(s) -
Lok Anna S. F.,
Lai ChingLung
Publication year - 1989
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840090119
Subject(s) - hepatocellular carcinoma , medicine , cirrhosis , asymptomatic , gastroenterology , hepatitis b virus , liver disease , alpha fetoprotein , hepatitis , carcinoma , virus , immunology
Two hundred ninety patients (203 men, 87 women), age 7 to 74 years (mean: 39.1 years), with chronic hepatitis B virus infection, were prospectively followed for a period of 1 to 4 years to determine the value of α‐fetoprotein monitoring in the early detection of hepatocellular carcinoma. At presentation, 66% of the patients were asymptomatic, 19% had chronic hepatitis and 15% had established cirrhosis. Forty‐four (15%) patients had elevated α‐fetoprotein levels on one or more occasions during the study period. Twenty patients with normal α‐fetoprotein levels at presentation developed elevated α‐fetoprotein levels during the course of follow‐up, whereas 24 patients had elevated α‐fetoprotein levels at presentation. Six (14%) of these 44 patients (five men and one woman), age 23 to 66 years, had persistent or progressive increase in α‐fetoprotein levels and were confirmed to have hepatocellular carcinoma. In four patients, the α‐fetoprotein levels were below 500 ng per ml at the time of tumor localization. Only three patients had resectable tumors. All six patients would have been missed if α‐fetoprotein screening was restricted to men above the age of 40 with cirrhosis and anti‐HBe. Of the remaining 38 patients, elevation in α‐fetoprotein levels in 18 patients was associated with exacerbations of the underlying liver disease and/or significant changes in level of hepatitis B virus replication, but in 20 patients, no apparent cause could be identified. The elevation in AFP levels exceeded 200 ng per ml in 26% and persisted beyond 6 months in 15% of these patients. We observed that elevation in α‐fetoprotein levels occurred quite frequently in patients with chronic hepatitis B virus infection. The differentiation between benign and malignant causes of α‐fetoprotein elevation was at times difficult. Thus, α‐fetoprotein monitoring alone is not a satisfactory tool in the early diagnosis of hepatocellular carcinoma.