Surveillance for hepatocellular carcinoma in a mixed-aetiology UK cohort with cirrhosis: does α-fetoprotein still have a role?

Gwilym J Webb, Kathryn Vc Wright, Elizabeth Cb Harrod, David A Gorard, Jane D Collier, Alexander Kc Evans

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Mortality from hepatocellular carcinoma (HCC) in people with cirrhosis is increasing whereas mortality from other causes is declining. Surveillance appears to reduce mortality but the optimal strategy is uncertain. Current guidelines differ by recommending ultrasonography alone or with α-fetoprotein (αFP). Records in three UK hospitals were analysed from 2006 to 2011. Of 111 HCC cases identified, 24 (47.1%) of those eligible were under surveillance: 21 (87.5%) were under combined ultrasonography-αFP, 2 (8.3%) ultrasonography-only and 1 (4.2%) αFP-only surveillance. αFP was elevated in 19 (86.4%), and αFP alone triggered a confirmatory study in 11 (9.9%) overall and 7 (29.1%) under surveillance. Surveillance, but not αFP, correlated with smaller tumours. Survival did not differ significantly between groups. Given that αFP use is associated with identifying smaller HCCs and that several diagnoses would have been delayed without αFP in this real-life cohort, these data support ongoing αFP use. However, further work is necessary with regard to whether αFP translates into improved clinical outcome and overall cost effects. In our area, stopping αFP use would also represent a significant change in practice.

Original languageEnglish
Pages (from-to)139-44
Number of pages6
JournalClinical Medicine
Volume15
Issue number2
DOIs
Publication statusPublished - Apr 2015

Bibliographical note

© 2015 Royal College of Physicians.

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular
  • Female
  • Great Britain
  • Humans
  • Liver Neoplasms
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Analysis
  • alpha-Fetoproteins

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