What is the major tumor marker for Hepatocellular Carcinoma (HCC)?

From the Guidelines

Alpha-fetoprotein (AFP) is the major tumor marker for hepatocellular carcinoma (HCC). AFP is a glycoprotein normally produced by the fetal liver and yolk sac that decreases after birth, with very low levels in healthy adults. Elevated serum AFP levels (typically >400 ng/mL) can indicate HCC, though sensitivity varies with approximately 60-70% of HCC patients showing elevated levels 1. AFP is particularly useful when monitored over time, as rising levels may suggest tumor progression or recurrence after treatment. However, it's essential to note that AFP has limitations - it can be elevated in other conditions like chronic hepatitis, cirrhosis, and certain non-HCC tumors, leading to false positives. Additionally, some HCC tumors, particularly well-differentiated and early-stage ones, may not produce AFP (AFP-negative HCC) 1. For this reason, AFP is typically used alongside imaging studies like ultrasound, CT, or MRI for HCC surveillance and diagnosis rather than as a standalone test. Other emerging biomarkers include des-gamma-carboxy prothrombin (DCP) and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), but AFP remains the most widely used tumor marker for HCC 1.

Some key points to consider when using AFP as a tumor marker for HCC include:

• Elevated AFP levels are associated with poorer prognosis and can predict risk of tumor recurrence after resection or liver transplantation 1
• AFP levels >200 and/or >400 ng/ml can be tested as prognostic factors of poor outcome in research investigations 1
• The combination of AFP and imaging studies like ultrasound can improve detection rates of HCC 1
• AFP is not a sensitive or specific diagnostic test for HCC, but results of AFP testing can be useful in conjunction with other test results to guide management of patients believed to have HCC 1

Overall, while AFP has its limitations, it remains a crucial tool in the diagnosis and management of HCC, and its use in conjunction with imaging studies and other biomarkers can help improve patient outcomes.

From the Research

Tumor Markers for HCC

• The major tumor marker for Hepatocellular Carcinoma (HCC) is alpha-fetoprotein (AFP) 2, 3, 4, 5, 6.
• AFP is a glycoprotein that belongs to the class of onco-development proteins and is recognized as an important blood component with specific diagnostic utilities 5.
• Elevated levels of AFP are often associated with HCC, as well as other malignant and chronic conditions, such as chronic liver disease 5.
• The combination of AFP with other tumor markers, such as Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) and des-gamma-carboxy prothrombin (DCP), can result in good predictive ability for patient survival after diagnosis 2.
• Other biomarkers, including AFP-L3, DCP, osteopontin, and GP73, are also being evaluated for early detection of HCC 4.

Diagnostic Significance of AFP

• AFP is a significant marker for HCC, helpful in assessing problems in management of HCC and monitoring treatment regimens 5.
• The diagnostic significance of AFP in HCC has been evaluated in several studies, which have shown that elevated levels of AFP are associated with HCC diagnosis 5.
• AFP levels can be used to monitor the progression of HCC and to evaluate the effectiveness of treatment 3.
• However, it is noted that AFP levels may not be elevated until the tumor is beyond surgical treatment, and other serum or tissue markers may not be particularly useful 3.