Alpha-fetoprotein has no prognostic role in small hepatocellular carcinoma identified during surveillance in compensated cirrhosis.

Abstract Alpha-fetoprotein is a tumour marker that has been used for surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis. The prognostic capability of this marker in patients with hepatocellular carcinoma has not been clearly defined. In this study our aim was to evaluate the prognostic usefulness of serum alpha-fetoprotein in patients with well-compensated cirrhosis, optimal performance status, and small hepatocellular carcinoma identified during periodic surveillance ultrasound who were treated with curative intent. Among the 3,027 patients included in the Italian Liver Cancer study group patients we selected 205 Child-Pugh class A and Eastern Cooperative Group Performance Status 0 cirrhotic patients with a single hepatocellular carcinoma ≤3 cm of diameter diagnosed during surveillance who were treated with curative intent (hepatic resection, liver transplantation, percutaneous ethanol injection, radiofrequency thermal ablation). Patients were sub-divided according to alpha-fetoprotein serum levels (i.e., normal ≤20 ng/mL; altered 21-200 ng/mL; diagnostic >200 ng/mL). Patients survival, as assessed by the Kaplan-Meier method, was not significantly different among the three alpha-fetoprotein classes (P=0.493). The same result was obtained in the subgroup of patients with a single hepatocellular carcinoma ≤2cm (P=0.714). An alpha-fetoprotein serum level of 100 ng/mL identified by receiver operating characteristic curve had inadequate accuracy (area under the curve=0.536, 95% confidence interval=0.465-0.606) to discriminate between survivors and deceased patients. CONCLUSIONS: Alpha-fetoprotein serum levels have no prognostic meaning in well-compensated cirrhotic patients with single, small hepatocellular carcinoma treated with curative intent. (HEPATOLOGY 2012.).