Johnson P J, Portmann B, Williams R
Br Med J. 1978 Sep 2;2(6138):661-3. doi: 10.1136/bmj.2.6138.661.
Serum alpha-fetoprotein (AFP) concentrations were estimated by sensitive radioimmunoassay in 30 patients with cirrhosis complicated by hepatocellular carcinoma and in 100 patients with cirrhosis in whom malignancy was excluded. Twenty-nine of the 30 patients with hepatocellular carcinoma had concentrations above 10 IU/ml (10.5 ng/ml) (median 3500 IU/ml (3675 ng/ml)), whereas only one of the 100 patients with cirrhosis and no tumour development had a raised concentration. Eleven out of 20 patients in whom hepatocellular carcinoma had developed in an apparently normal liver had raised AFP concentrations. In this group the differential diagnosis is usually secondary carcinoma, and three of 50 such patients had AFP concentrations above 10 IU/ml. Noting raised AFP concentrations is thus of considerable value both in detecting and in excluding hepatocellular carcinoma in cirrhosis, for in this case such concentrations gave only 1% false-positive and 3% false-negative results. They are less useful, however, in distinguishing between primary tumours arising in patients without cirrhosis and secondary hepatic deposits, giving 6% false-positive and 45% false-negative results.
采用灵敏的放射免疫分析法对30例肝硬化合并肝细胞癌患者及100例排除恶性肿瘤的肝硬化患者的血清甲胎蛋白（AFP）浓度进行了测定。30例肝细胞癌患者中有29例的浓度高于10 IU/ml（10.5 ng/ml）（中位数为3500 IU/ml（3675 ng/ml）），而100例无肿瘤发生的肝硬化患者中只有1例浓度升高。在20例肝脏表面看似正常却已发生肝细胞癌的患者中，有11例的AFP浓度升高。在这组患者中，鉴别诊断通常为继发性癌，50例此类患者中有3例的AFP浓度高于10 IU/ml。因此，注意到AFP浓度升高对于在肝硬化患者中检测和排除肝细胞癌具有重要价值，因为在这种情况下，此类浓度的假阳性结果仅为1%，假阴性结果为3%。然而，它们在区分无肝硬化患者的原发性肿瘤和继发性肝转移方面作用较小，假阳性结果为6%，假阴性结果为45%。
