Article: Alpha-fetoprotein above normal levels as a risk factor for the development of hepato-cellular carcinoma in patients infected with hepatitis C virus by Tateyama M, Yatsuhashi H, Taura N, et al. J Source: Gastroenterol. 2010 Aug 14. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/20711614
Alfa-fetoprotein (AFP) is a blood test that is used widely to detect abnormalities that may be an indication of the presence of certain types of cancers. In pregnant woman, the test is used to find out if the baby is more likely to have certain birth defects. In viral hepatitis it is a test used to indicate liver cancer. However, it is not always an accurate test so liver imaging is used in conjunction with the test to detect possible liver cancer. In people with chronic hepatitis B the AFP test and a liver imaging test are recommended every 6 to 12 months regardless of how much the liver is damaged. In people with chronic hepatitis C most providers will generally start monitoring for liver cancer using the AFP test and liver imaging once someone has developed severe fibrosis or cirrhosis.
In the current study, a total of 707 patients with chronic hepatitis C were evaluated for liver cancer prior to beginning an HCV clinical trial or before starting interferon treatment. They looked at many factors including age, gender, HCV RNA (viral load), HCV genotype, fibrosis level, liver biochemical levels, platelet counts and alpha-fetoprotein levels. Fibrosis was classified into 4 stages with F0/1 being no or minimal activity up to F4 being severe fibrosis /cirrhosis.
The results found that the increasing rate of liver cancer over 10-years was 2.5% (F0/F1); 12.8 % (F2); 19.3% (F3) and 55.9% (F4). The authors noted that certain factors increased the risk for the development of liver cancer including age 57 years old or older, fibrosis/cirrhosis stage F4, AFP levels of 6 to 20 ng/mL and levels greater than or equal to 20 ng/mL). The authors also reported that the ten-year cumulative incidence rate of liver cancer for patients with AFP levels (ng/mL) lower than 6 was 6.0%; 6 to 20 was 24.6%, and if levels were greater than or equal to 20 it was 47.3%.
The authors concluded that “[N]ot only high (>20 ng/mL) levels, but also even slightly elevated (6-20 ng/mL) AFP levels, could serve as a risk factor for HCC to complement the fibrosis stage.” The authors also noted that the AFP levels of less than 6 ng/mL show a low risk for the development of liver cancer in people with chronic hepatitis regardless of the stage of fibrosis.
The Bottom Line: In people with chronic hepatitis C, frequent monitoring of liver cancer with the AFP test and imaging is needed in people with severe fibrosis or cirrhosis regardless of AFP levels. It is reassuring to know, however, that regardless of HCV disease progression, a person who has an AFP level below 6 ng/mL carries a very low risk for developing liver cancer.Share This Page