AFP-Negative Hepatocellular Carcinoma

An US image of the liver shows a 2 cm solid nodule in a cirrhotic liver.

CT images of the liver in arterial and portovenous phases show arterial contrast enhancement with rapid washout of the nodule.

Facts: Serum AFP & Hepatocellular Carcinoma (HCC)

• First detection of AFP in serum of HCC patients in 1970s
• Currently, it is the only widely used serologic marker for diagnosing HCC. Additional useful markers in use are AFP-L3 and DCP
• Normal range 10-20 ng/mL
• AFP greater than 400 ng/mL generally considered a point of discriminating HCC from other chronic liver disease
• Problem: about 60% of patients with HCC have AFP below 200, up to 20% have normal AFP (AFP-negative HCC; AFP below 20)

Clinical Features of AFP-negative HCC

• Less likely to be hepatitis B positive
• Tend to have a lower level of ratio of serum glutamic oxaloacetic transaminase (AST)/pyruvic transaminase (ALT)

References:

1. Law WY. Hepatocellular Carcinoma, 2007.

2. Nomura F, Ohnishi K, Tanabe Y. Clinical features and prognosis of hepatocellular carcinoma with reference to serum alpha-fetoprotein levels. Analysis of 606 patients. Cancer 1989;64:1700-1707.