Hepatitis B- and hepatitis C-associated hepatocellular carcinoma: evaluation of alpha-fetoprotein as a diagnostic marker.

Hepatocellular carcinoma (HCC) is one of the most common cancers, especially in Asia and Africa. The prognosis of HCC is very poor because of the high malignancy and the failure of early diagnosis which is mainly dependent on the late onset of clinical symptoms. Chronic infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) is the most commonly known risk factor for developing HCC. Mass screening and monitoring of general population or of high-risk population, by measurement of serum alpha-fetoprotein (AFP), have been implemented in several countries. However, the use of AFP as a diagnostic marker for HCC is questionable due to its limited sensitivity and specificity. This article analyzed the serum level of AFP in 72 histopathologically confirmed hepatocellular carcinoma cases in Thailand. Elevation of serum AFP was detected in 75.6%, 88.9%, 79.2% and 80.0% of patients with HBsAg, anti-HCV antibody, HBV DNA, and HCV RNA, respectively. However, only 58.8% of HCC patients without any of the four markers had elevation of serum AFP. AFP is thus not a sensitive screening marker for HCC in general population, especially in those not associated with HBV or HCV. However, since elevated serum AFP was found in most patients with evidence of HBV or HCV infection, the monitoring of serum AFP level in those high-risk patients can be valuable for screening and monitoring of hepatocellular carcinoma.