In an attempt to investigate the factors influencing the specificity of serum level of alphafetoprotein (AFP) for hepatocellular carcinoma, seru levels of AFP were analyzed in 33 patients treated at the department of gastroenterology in the Korea
Cancer
Center Hospital between January 1989 and December 1991. All patients entered into the study had chronic liver disease with increased serum level of AFP, more than 50 ng/ml. Clinical and laboratory parameters, such as HBsAg, Anti-HCV, GOT and GPT
and
image studies with ultrasonography and computed tomography were sequentially evaluated, every two or three months, in 22 patients. Among 33 patients, 30 had liver cirrhosis and three had chronic hepatitis. The moedian level of serum AFP was 189
ng/ml in
33 patients. Thirty (90.9%) out of 33 patients wee positive for HBsAg. anti-HCV was tested in 14 patients, among whom four (28.6%) were positive. No significant corelation was observed between serum AFP levels and age, sex or positive rates for
HBsAg,
anti-HCV and cirrhosis. In 32 among 33 patients, no evidence of the development of hepatocelle rcarcinoma was found after the follow-up period of six to 36 months, when hepatocellar carcinoma was diagnosed as the space occupying lesion in the
lier
by
ultrasonogrpahy and computed tomography. another one patient was also suggested not to develop hepatocellar carcinoma, when clinically evaluated, because liver function and serum AFP level were markedly improved. The follow-up period in 22
patinets
was
determined as the period until the AFP level decreased bclow the cut-off value, 50 ng/ml, or the end of study period. The serum AFP level and liver function were sequentially tested during the median follow-up period of 7.5 months (range, 3-30),
demonstrating that the median serum AFP level significantly decreased from 376.6 ng/ml to 57.6 ng/ml (p<0.05). With the decreasein serum AFP levels, serum levels of GOT and GPT also decreased (p<0.01). In 20 out of 22 patients, serum level of AFP
decreased to less than 50% of the inital level of AFP after the follow-up period. In eight and seven patients, serum levels of AFP decreased to the normal level., less than 20 ng/ml, after the median follow-up period of 14.5 months (range, 5-30)
and
20-49 ng/ml during 4.5 months (range, 3-11), respectively. In two patients, however, change in the serum AFP levels was not observed. In seven patients who had the initial serumn AFP level of more than 100ng/ml and tested serum AFP level and
liver
function test every two months, serum levels of AFP, GOT and GPT concurrently decreased during the follow-up period. These results demonstrating that serum AFP level increased in benign liver diseases, such as liver cirrhosis and chronic
hepatitis,
suggest that, in order to increase the lcinical usefulness of serum level of AFP for the diagnosis of hepatocellular carcinoma, serum AFP level should be reevaluated for the specificity for hepatocellular carcinoma according to the cut-off value.
Because serum AFP level decreased in most of the patients after the follow-up period, it is also suggested that AFP elevated in benign liver disese might be different from that in hepatocellular carcinoma in molecular characteristics.
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