Utility of alpha-fetoprotein (AFP) in the screening of patients with virus-related chronic liver disease: Does different viral etiology influence AFPlevels in HCC? A study in 350 western patients

Background/Aims: Dosage of serum AFP (alpha -fetoprotein) is widely used fo r HCC screening in patients with chronic liver disease. Virus-related chron ic liver disease is the main cause of cirrhosis and HCC in Western and Far Eastern countries, but the relationship between viral etiology and AFP leve ls in HCC is still unclear. The aim of this study was to verify, in Western patients with post-viral chronic liver disease, the usefulness of AFP dosa ge for the detection of HCC, and the influence of viral etiology on AFP lev els in HCC. Methodology: The study population included 350 patients with post viral chr onic liver disease that underwent Liver biopsy, serum AFP determination and ultrasound liver evaluation. Seven patients had normal liver histology, 19 7 had chronic hepatitis, 72 had cirrhosis, and 74 had cirrhosis and HCC. RO C (receiver operating characteristic) analysis was used to assess the best diagnostic AFP threshold value for HCC detection. Logistic regression analy sis was performed to individuate independent predictors of HCC diagnosis. Results: No difference was observed in AFP levels between HCV- and HBV-posi tive patients, neither in the whole population nor in the HCC patients only . ROC area under curve for AFP was 0.801 (95% CI: 0.721-0.867). The analysi s individuated a best accurate AFP threshold value for HCC diagnosis of 50n g/mL. HCC was detected with specificity greater than or equal to 95% only f or AFP >100ng/mL. The sensitivity however was poor (25%). Male sex, age >60 , and AFP were independent predictors of HCC diagnosis. Conclusions: Serum AFP levels in HCC patients are not influenced by virus B or C hepatitis pattern. AFP dosage should not be used for HCC diagnosis in non-cirrhotic patients. Male patients with cirrhosis should be regarded wi th a more "aggressive" screening program compared to females.