The effectiveness of serum alpha-fetoprotein level in anti-HCV positive patients for screening hepatocellular carcinoma

BACKGROUND/AIMS: In Taiwan, most cases of hepatocellular carcinoma (HCC) ar e hepatitis B virus (HBV) or hepatitis C virus (HCV) related. The serum a-f etoprotein (AFP) level is an important factor in the diagnosis of HCC. Ther e have been many studies discussing the role of AFP in diagnosing HBV-relat ed HCC, but only few concerning HCV-related HCC. In this study, we aimed at analyzing the distribution of AFP levels in anti-HCV positive patients wit h and without HCC and evaluating the effectiveness of serum AFP levels in s creening HCV-related HCC. METHODOLOGY: From 1993-1996, we collected the AFP data of 205 HCC patients retrospectively, who were anti-HCV positive. For comparison, 131 randomized anti-HCV positive patients without evidence of HCC served as the control g roup. We analyzed the AFP distribution in both groups over the following ra nges: less than or equal to 5ng/ml, >5-20ng/ml, >20-50ng/ml, >50-100ng/ml, > 100-200ng/ml and >200-400ng/ml, and >400ng/ml. RESULTS: The distributions of AFP levels in anti-HCV positive patients with HCC were 13.2%, 21.5%, 11.2%, 4.9%, 4.4%, 7.3%, and 37.6%. The distributio ns in anti-HCV positive patients without evidence of HCC were 34.3%, 55.0%, 8.4%, 1.5%, 0.8%, 0%, 0%. CONCLUSIONS: We found the differences in AFP to be statistically significan t between anti-HCV positive patients with and without HCC. A serum AFP leve l of more than 200ng/ml highly indicates HCC. However, there is a large ove rlap between these 2 groups. Thus, in anti-HCV positive patients, AFP level is not a good single reference for diagnosis of HCC. Anti-HCV positive pat ients should be routinely screened for HCC by image studies along with seru m AFP level.