From the Guidelines
Alpha-fetoprotein (AFP) is the most commonly used marker for liver cancer, particularly hepatocellular carcinoma (HCC), with normal levels typically below 10 ng/mL and levels above 400 ng/mL strongly suggesting HCC in high-risk patients. According to the most recent and highest quality study 1, liver ultrasonography (US) is the recommended imaging tool and serum alpha-feto protein (AFP) is a predictive tumoral biomarker most widely used for surveillance of HCC. The study suggests that liver US every 6 months with or without AFP level is universally accepted modality for HCC surveillance due to low cost and ease of availability.
Some key points to consider when using AFP as a marker for liver cancer include:
- AFP has limitations as it's elevated in only 60-70% of HCC cases and can also increase with other liver conditions like cirrhosis and hepatitis 1
- For more comprehensive screening, AFP should be combined with liver ultrasound every 6 months in high-risk patients (those with cirrhosis or chronic hepatitis B) 1
- Additional markers that may be used include des-gamma-carboxy prothrombin (DCP), AFP-L3 (a specific AFP isoform), and glypican-3, which improve diagnostic accuracy when used together 1
- AFP levels can also help monitor treatment response and detect recurrence after therapy, with rising levels potentially indicating disease progression 1
It's worth noting that the effectiveness of these markers varies based on tumor size, with smaller tumors being more difficult to detect through serum markers alone, which is why imaging remains essential in the diagnostic process 1. Overall, the combination of AFP and liver ultrasound every 6 months is the most effective approach for screening high-risk patients for liver cancer.
From the Research
Liver Cancer Markers
- Alpha-fetoprotein (AFP) is a key marker of liver cancer, playing a crucial role in regulating the proliferation of tumor cells, apoptosis, and induction of cellular immune escape 2.
- Approximately 70% of liver cancer patients show increased serum Alpha-Fetoprotein (AFP) levels, making it the main diagnostic and prognostic indicator of liver cancer 2.
- Carbohydrate antigen 199 (CA199) is also used as a tumor marker in the diagnosis of liver cancer, often in combination with AFP 3.
Diagnostic Value of Liver Cancer Markers
- The combination of contrast-enhanced ultrasound and enhanced CT with tumor markers AFP and CA199 significantly improves the sensitivity and accuracy of liver cancer diagnosis 3.
- AFP is highly expressed in liver cancer cells and is used as a target antigen in immunotherapy for liver cancer 2.
- The detection of free alpha-fetoprotein (AFP) and AFP-IgM complexes can improve the detection of liver cancer, with 82% of patients positive for at least one marker 4.
Prognostic Value of Liver Cancer Markers
- Elevated baseline AFP levels are associated with shorter progression-free survival and overall survival in patients with advanced hepatocellular carcinoma 5.
- AFP level is an independent prognostic factor for progression-free survival and overall survival in patients with advanced hepatocellular carcinoma 5.
- AFP is also used to guide therapeutic choice in hepatocellular carcinoma and monitor treatment 6.