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Racial Differences in Effectiveness of Alpha-fetoprotein for Diagnosis of Hepatocellular Carcinoma in Hepatitis C Virus Cirrhosis

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  • claudine intexas
    Gastroenterology, August 2002 Journal Scan From Hepatology August 2002 (Volume 36, Number 2) Racial Differences in Effectiveness of Alpha-fetoprotein for
    Message 1 of 1 , Sep 14, 2002
      Gastroenterology, August 2002 Journal Scan

      From
      Hepatology
      August 2002 (Volume 36, Number 2)

      Racial Differences in Effectiveness of Alpha-fetoprotein for
      Diagnosis of Hepatocellular Carcinoma in Hepatitis C Virus Cirrhosis
      Nguyen MH, Garcia RT, Simpson PW, Wright TL, Keeffe EB
      Hepatology. 2002;36(2):410-417

      What is the diagnostic utility of serum alpha-fetoprotein (AFP) for
      hepatitis C-related hepatocellular carcinoma (HCC) in North American
      patients with their ethnic diversities?

      HCC is well established as a complication of chronic viral hepatitis,
      and in fact, the majority of Americans with this malignancy have
      underlying hepatitis C virus (HCV) infection. The current
      recommendations for screening for HCC among cirrhotic patients
      dictate twice-yearly serum AFP and liver ultrasound. Serum levels of
      AFP -- a fetal glycoprotein -- fall rapidly after birth to < 10 ng/mL
      and only increase again in the setting of specific pathologic
      conditions. Although the association of increased serum AFP with HCC
      has been established for nearly 4 decades, AFP is also increased in
      other nonhepatic and benign conditions. As a result, the utility of
      serum AFP as a diagnostic marker of HCC in North American patients
      with hepatitis C-related HCC remains undefined. To these
      investigator's knowledge, no studies to date have assessed the
      diagnostic role of serum AFP for hepatitis C-related HCC in the North
      American population with its inherent racial/ethnic diversity. In
      addition, most available data regarding serum AFP derives from
      investigation of patients with chronic hepatitis B or other chronic
      liver diseases of mixed etiologies.

      Thus, Nguyen and colleagues conducted this multicenter,
      retrospective, case-control study to assess the diagnostic utility of
      serum AFP for HCC in patients with HCV-related cirrhosis from diverse
      ethnic backgrounds. This study involved 163 patients with HCV-related
      HCC and 149 control patients with HCV-related cirrhosis. For those
      patients with HCC, correlations between AFP values and disparate
      patient and tumor characteristics were examined. Sensitivity and
      specificity of various AFP cutoff values were determined as follows:
      (1) for AFP > 10 ng/mL (normal upper limit for most commercial
      laboratories); (2) for AFP > 20 ng/mL (recommended level indicating
      need for further investigation); and (3) for AFP > 100 ng/mL and 200
      ng/mL (recommended confirmatory values for HCC in patients with
      hepatic masses).

      Overall, results showed that the rate of serum AFP increase seemed to
      vary among the various ethnic groups in this study. The positive
      likelihood ratios for AFP at 0-20, 21-50, 51-100, and 101-200 ng/mL
      were 0.46, 1.31, 1.15, and 6.90, respectively. Whereas only a small
      portion of Asian, white, and Hispanic patients with HCV-related HCC
      (18%) had normal serum AFP, 43% of black patients presented with HCC
      and a normal AFP level. Blacks were also more likely to present with
      larger tumors and multilobar disease. The sensitivity of AFP for the
      diagnosis of HCC in blacks with HCV infection was less than that
      found for patients of all other ethnic groups combined.

      Thus based on these findings, it appears that AFP values greater than
      200 ng/mL have utility as a diagnostic marker for HCC in patients
      with HCV-related cirrhosis and a liver mass. However, these data also
      suggest that AFP does not have sufficient sensitivity to confirm HCC
      in the black population. More frequent and sensitive imaging studies
      may be warranted for effective screening for HCC in this ethnic
      group.


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