From the Guidelines
No, elevated alpha beta protein levels are not seen in hepatocellular carcinoma. The correct tumor marker associated with hepatocellular carcinoma (HCC) is alpha-fetoprotein (AFP), not alpha beta protein. AFP is a glycoprotein normally produced by the fetal liver and yolk sac that decreases after birth. Elevated serum AFP levels are found in approximately 50%–75% of patients with HCC, making it a useful diagnostic marker 1. However, it's essential to note that AFP is not specific to HCC alone, as elevated levels can also be seen in other conditions such as pregnancy, certain testicular tumors, and some gastrointestinal cancers. Additionally, not all HCC cases show elevated AFP, particularly in early-stage disease or well-differentiated tumors. Other markers used in HCC diagnosis include des-gamma-carboxy prothrombin (DCP) and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3). The most recent and highest quality study, published in 2010, supports the use of AFP as a diagnostic marker for HCC, with elevation of AFP >400 ng/ml being used instead of fine needle cytology for diagnosis in patients with liver cirrhosis and a focal hypervascular liver lesion (>2 cm) in at least one imaging technique 1. Key points to consider in the diagnosis of HCC include:
- The use of imaging techniques such as ultrasound, MRI, or CT scan to detect liver masses consistent with HCC
- The importance of confirming diagnosis through fine needle aspiration or biopsy
- The role of AFP in diagnosis, particularly in patients with liver cirrhosis and a focal hypervascular liver lesion (>2 cm) in at least one imaging technique
- The need for surveillance programs to detect HCC in cirrhotic patients and/or HBV/HCV carriers.
From the Research
Elevated Alpha-Fetoprotein Levels in Hepatocellular Carcinoma
- Elevated alpha-fetoprotein (AFP) levels are often associated with hepatocellular carcinoma (HCC) 2, 3.
- A systematic review and meta-analysis found that AFP levels in serum showed good accuracy in HCC diagnosis, and a threshold of 400 ng/mL was better than 200 ng/mL in terms of sensitivity and specificity 2.
- Another study found that AFP levels were independently associated with stage III/IV hepatic fibrosis, elevated aspartate aminotransferase (AST), and prolonged prothrombin time in patients with chronic hepatitis C 4.
- A review of the biology and significance of AFP in HCC found that AFP remains the most widely used and accepted serum marker for HCC, despite the discovery of other biomarkers 3.
Clinical Significance of Elevated AFP Levels
- Elevated AFP levels can be seen in patients with chronic hepatitis C, but not necessarily in those with HCC 4, 5.
- A case report found that a patient with chronic hepatitis C had markedly elevated AFP levels without HCC, which normalized after continued treatment with interferon 5.
- The clinical significance of elevated AFP levels in patients with HCC is still being researched, with some studies suggesting that AFP can be used as a prognostic and predictive biomarker 3.