Improving the efficacy of α-fetoprotein in the surveillance setting

▸ Philip Hendy and Nik Ding reviewing El-Serag et al.1

The incidence of hepatocellular carcinoma (HCC) is increasing in the Western world. When identified early, HCC is often curable, while advanced tumours have a very high mortality. Recent studies continue to demonstrate poor outcomes for patients with HCC, with overall 5-year survival <20%.2 Those at risk of HCC, mainly patients with hepatic cirrhosis, should undergo regular HCC surveillance, which has been shown to allow earlier, asymptomatic diagnosis.3 Randomised controlled trial (RCT) data on the benefits of surveillance for HCC are scant, but a single RCT of over 18 000 at-risk subjects showed a 37% reduction in mortality for the surveillance group.4 Traditionally, the combination of ultrasonographic and serum α-fetoprotein (AFP) testing has been advocated.5 While recent concerns over the limitations of AFP in the surveillance setting have led to its removal as a surveillance test from some society guidelines, it is still frequently used in clinical practice.6 A distinction should be made between using AFP as a diagnostic test …