Elevated Alpha-Fetoprotein : Differential Diagnosis - Hepatocellular Carcinoma and Other Disorders - 24/04/15

Doi : 10.1016/j.cld.2015.01.005

Robert J. Wong, MD, MS ^a, Aijaz Ahmed, MD ^b,^c, Robert G. Gish, MD ^c,^d,^⁎
^a Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, Highland Care Pavilion, 5th floor, 1411 East 31st Street, Oakland, CA 94602, USA
^b Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite# 210, Palo Alto, CA 94304, USA
^c Liver Transplant Program, Stanford University Medical Center, 750 Welch Road, Suite# 210, Palo Alto, CA 94304, USA
^d Hepatitis B Foundation, 3805 Old Easton Road, Doylestown, PA 18902, USA

^∗Corresponding author. Robert G. Gish Consultants LLC, 6022 La Jolla Mesa Drive, San Diego, CA 92037.

Résumé

The incidence of cirrhosis-related hepatocellular carcinoma (HCC) is rising. Curative surgical options are available; outcomes are acceptable with early diagnosis. Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) and des-gamma-carboxy prothrombin (DCP) are HCC risk markers. A high or increasing serum biomarker level can be predictive of the eventual development of HCC, large tumor size, advanced stage, extrahepatic metastases, portal vein thrombosis, and postoperative HCC recurrence. Based on FDA guidelines for HCC risk assessment, clinicians can consider using either the combination of AFP-L3 with DCP, or the combination of AFP-L3 with AFP and DCP.

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Keywords : Hepatocellular carcinoma, Alpha-fetoprotein, Chronic hepatitis C virus infection, Chronic hepatitis B virus infection, Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein, Des-gamma-carboxy prothrombin