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      Update on the applications and limitations of alpha-fetoprotein for hepatocellular carcinoma

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          Abstract

          Alpha-fetoprotein (AFP) is an oncofetal glycoprotein that has been used as a tumor marker for hepatocellular carcinoma (HCC) in combination with ultrasound and other imaging modalities. Its utility is limited because of both low sensitivity and specificity, and discrepancies among the different methods of measurements. Moreover, its accuracy varies according to patient characteristics and the AFP cut-off values used. Combination of AFP with novel biomarkers such as AFP-L3, Golgi specific membrane protein (GP73) and des-gamma-carboxyprothrombin significantly improved its accuracy in detecting HCC. Increased AFP level could also signify severity of hepatic destruction and subsequent regeneration and is commonly observed in patients with acute and chronic liver conditions and cirrhosis. Hereditary and other non-hepatic disorders can also cause AFP elevation.

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          Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases

          Jorge A Marrero, Laura M Kulik, Claude Sirlin … (2018)
          Article 0 comments Cited 1354 times – based on 0 reviews     Review now
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            Asia–Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update

            Masao Omata, Ann-Lii Cheng, Norihiro Kokudo … (2017)
            There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.
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              Epidemiology and surveillance for hepatocellular carcinoma: New trends

              Amit G. Singal, Pietro Lampertico, Pierre Nahon (2020)
              The burden of hepatocellular carcinoma (HCC) is highest in East Asia and Africa, although its incidence and mortality are rapidly rising in the United States and Europe. With the implementation of hepatitis B vaccination and hepatitis C treatment programmes worldwide, the epidemiology of HCC is shifting away from a disease predominated by viral hepatitis - an increasing proportion of cases are now attributable to non-alcoholic steatohepatitis. Surveillance using ultrasound, with or without alpha-fetoprotein, every 6 months has been associated with improved early detection and improved overall survival; however, limitations in implementation lead to a high proportion of HCC being detected at late stages in clinical practice. Herein, we review the current state of HCC surveillance and highlight areas for future research, including improved risk stratification of at-risk patients, surveillance tools with higher sensitivity and specificity for early HCC, and interventions to increase surveillance utilisation.
              Article 0 comments Cited 376 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Hira Hanif
                Mukarram Jamat Ali
                Ammu T Susheela
                Iman Waheed Khan
                Maria Alejandra Luna-Cuadros
                Muzammil Muhammad Khan
                Daryl Tan-Yeung Lau
                Journal
                Journal ID (nlm-ta): World J Gastroenterol
                Journal ID (iso-abbrev): World J Gastroenterol
                Journal ID (publisher-id): WJG
                Title: World Journal of Gastroenterology
                Publisher: Baishideng Publishing Group Inc
                ISSN (Print): 1007-9327
                ISSN (Electronic): 2219-2840
                Publication date (Print): 14 January 2022
                Publication date (Electronic): 14 January 2022
                Volume: 28
                Issue: 2
                Pages: 216-229
                Affiliations
                Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
                Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
                Internal Medicine, Loyola MacNeal Hospital, Berwyn, PA 60402, United States
                Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
                Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
                Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
                Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States. dlau@ 123456bidmc.harvard.edu
                Author notes

                Author contributions: Hanif H and Ali MJ contributed equally; Lau DTY provided the concept and direction of the review, the learning points and the editing of the manuscript; Khan MM, Hanif H, Ali MJ, Susheela AT, and Luna-Cuadros MA reviewed the literature and wrote the first manuscript draft; Khan IW and Ali MJ contributed to the addition of literature, revision and edition of the final manuscript; Khan MM and Lau DTY are joint senior authors.

                Corresponding author: Daryl Tan-Yeung Lau, MD, MSc, Associate Professor, Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St. Liver Research Center, Suite 4A, Boston, MA 02215, United States. dlau@ 123456bidmc.harvard.edu

                Article
                Other ID: jWJG.v28.i2.pg216
                DOI: 10.3748/wjg.v28.i2.216
                PMC ID: 8776528
                PubMed ID: 35110946
                SO-VID: d8503159-7189-4554-a4a4-85ec2604fa4d
                Copyright © ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

                History
                Date received : 4 October 2021
                Date revision received : 26 November 2021
                Date accepted : 31 December 2021
                Categories
                Subject: Minireviews

                Keywords: alpha-fetoprotein,hepatocellular carcinoma,alpha-fetoprotein-l3,cirrhosis,tumor markers,hereditary persistence of alpha-fetoprotein
                Data availability:
                Keywords: alpha-fetoprotein, hepatocellular carcinoma, alpha-fetoprotein-l3, cirrhosis, tumor markers, hereditary persistence of alpha-fetoprotein

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