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Ko, Bae, Sinn, Gwak, Kang, Paik, Choi, Lee, Koh, and Paik: The Clinical Significance of Serum Alpha-fetoprotein in Diagnosing Hepatocellular Carcinoma in a Health Screening Population
Original Article
Liver

The Korean Journal of Gastroenterology 2017; 69(4): 232-238.

Published online: 25 April 2017

DOI: https://doi.org/10.4166/kjg.2017.69.4.232

The Clinical Significance of Serum Alpha-fetoprotein in Diagnosing Hepatocellular Carcinoma in a Health Screening Population

Young Sun Ko, Joo Hwan Bae, Dong Hyun Sinn, Geum-Youn Gwak, Wonseok Kang, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik

Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Dong Hyun Sinn, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, dh.sinn@samsung.com

Received 19 October 2016       Revised 10 December 2016       Accepted 16 December 2016

Copyright © 2017. Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Serum alpha-fetoprotein (AFP) measurement is commonly included in a health check-up program in Korea. However, its benefits remain uncertain. We analyzed whether AFP measurement should be included in a general health check-up program to screen for hepatocellular carcinoma (HCC).

Methods

A total of 36,552 adults aged 18 years or older—who participated in a routine health examination including AFP determination between January 2009 and December 2009 at the Health Promotion Center, Samsung Medical Center, South Korea—were analyzed. High risk of HCC was defined as positivity for hepatitis B surface antigen, anti-hepatitis C virus antibody or having liver cirrhosis.

Results

AFP level >10 ng/mL was observed in 27 participants (0.1%) and primary liver cancer was diagnosed in 9 patients (6 HCC and 3 cholangiocarcinoma). Among 1,619 participants with high risk factors of HCC, AFP level >10 ng/mL was observed in 16 participants, of which, 4 diagnoses were made. Sensitivity, specificity, positive predictive value, and negative predictive value of AFP for HCC was 0.66, 0.99, 0.25 and 0.99, respectively, for high risk participants. Among 34,933 participants without risk factors for HCC, 11 patients (<0.1%) showed elevated AFP levels above 10 ng/mL, and no case was diagnosed with primary liver cancer during a median follow-up period of 36 months (range: 0-48 months).

Conclusions

AFP elevation was rare in participants without risk factors for HCC, and was unable to screen for HCC in this population. We discourage routine AFP measurements for asymptomatic adults without risk factors of HCC.

Keywords: Alpha-fetoprotein, Hepatocellular carcinoma, Diagnosis

Figures and Tables

Table 1

Baseline Characteristics

kjg-69-232-i001

Values are presented as mean±standard deviation or number (%).

HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus.

aIncluding one patient with hepatitis B virus and hepatitis C virus co-infection; bPercent among individual with cirrhosis.

Table 2

Clinical Characteristics of Participants Who were Diagnosed with Primary Liver Cancer

kjg-69-232-i002

HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; ALT, alanine aminotransferase; AFP, alpha-fetoprotein; HCC, hepatocellular carcinoma; CCC, cholangiocarcinoma; M, male; F, female; N/A, not applicable.

aModified International Union Against Cancer (UICC) stage for HCC and the American Joint Committee on Cancer (AJCC) stage for CCC.

Table 3

Distribution of Serum Alpha-fetoprotein Level

kjg-69-232-i003

Values are presented as mean (range) or number (%).

aHigh risk was defined for patients with hepatitis B surface antigen, hepatitis C antibody or liver cirrhosis.

Table 4

Clinical Characteristics of Participants with Elevated Serum Alpha-fetoprotein Levels

kjg-69-232-i004

AFP, alpha-fetoprotein; HBsAg, hepatitis B surface antigen; HCV, hepatitis C; ALT, alanine aminotransferase; CT, computed tomography; CCC, cholangiocarcinoma; HCC, hepatocellular carcinoma; H, high risk group; N, low risk group; M, male; F, Female; NP, not-performed; P, performed; D, detected tumor; N, no tumor; FU, follow-up.

aUS is performed for all participants, while additional CT evaluation was performed for nine patients.

Table 5

Diagnostic Performance of Elevated Alpha-fetoprotein Levels for Hepatocellular Carcinoma

kjg-69-232-i005

PPV, positive predictive value; NPV, negative predictive value.

Notes

Financial support None.

Conflict of interest None.

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