Chaminda SR, et al. - The physicians examined the significance of pre-treatment alpha-fetoprotein (AFP) in a cohort of patients with non-viral hepatocellular carcinoma (nvHCC). In diagnosing nvHCC, pre-treatment AFP has a limited value. Findings revealed that having an AFP value over 400 ng/ml was correlated with aggressive tumour behaviour and poor prognosis.

Methods

• The physicians screened patients with nvHCC who were referred to a Hepatobiliary Clinic from September 2011-2015.
• They diagnosed HCC using American Association for the Study of Liver Disease guidelines, and TNM staged.
• nvHCC was diagnosed when HBsAg and anti-HCVAb were negative.
• They calculated Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores.
• They evaluated AFP level against patient characteristics, tumour characteristics, and survival.

Results

• The physicians screened 389 patients with nvHCC [age 64(12-88) years; 344(88.4%) males].
• Median AFP was 25.46 ng/ml (1.16-100,000).
• Among all patients, 41.2% (n = 160) had normal AFP level.
• In this study, 22.9% (n = 89) had AFP over 400 ng/ml.
• They observed higher AFP levels among 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.
• AFP over 400 ng/ml was found in diffuse type (P < 0.001), macro vascular invasion (P < 0.001) and late stage tumours (P < 0.001).
• Having AFP below 400 ng/ml was correlated with longer survival (16 vs 7 months, P < 0.001).