Image: An immunohistochemistry of anti-Alpha-Fetoprotein (AFP) antibody on liver tissue from a human hepatocellular carcinoma patient (Photo courtesy of Arigo Biolaboratories).
While the incidence of most cancers is decreasing in the USA the incidence of liver cancer has increased by 2.7% a year over the last 10 years, which is estimated at about 40,700 new cases of liver cancer that will be diagnosed in the USA in 2018.
Risk factors for liver cancer, also known as hepatocellular carcinoma or HCC, include hepatitis C infection, chronic heavy alcohol consumption, and nonalcoholic fatty liver disease related to diabetes and obesity. Symptoms can include upper abdominal pain or swelling, loss of weight or appetite, white chalky stools, and general fatigue.
Hepatologists at the UT Southwestern Medical Center (Dallas, TX, USA), carried out a meta-analysis of 32 previous studies comprising 13,367 patients, that characterized sensitivity of imaging with or without alpha fetoprotein (AFP) measurement for detection of HCC in patients with cirrhosis. They searched for data from January 1990 through August 2016 to identify published sensitivity and specificity of surveillance strategies for overall and early detection of HCC. AFP is a plasma protein that is produced in abundance by the liver cells in the fetus. In adults, AFP levels are normally low, but liver cancer can cause AFP levels to rise.
They found that ultrasound detected any stage HCC with 84% sensitivity, but early-stage HCC with only 47% sensitivity. In studies comparing ultrasound with versus without AFP measurement, ultrasound detected any stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (relative risk [RR], 0.88) and early-stage HCC with a lower level of sensitivity than ultrasound plus AFP measurement (RR, 0.81). However, ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement (RR, 1.08). Ultrasound with versus without AFP detected early-stage HCC with 63% sensitivity and 45% sensitivity, respectively.
Amit G, Singal, MD, who holds a Professorship in Clinical Cancer Research and was the lead investigator of the study, said, “Liver cancer screening in patients with chronic liver disease has traditionally been performed using an abdominal ultrasound. While ultrasound is readily available and noninvasive, it misses many cancers when they are small. Our study found that adding the blood biomarker alpha fetoprotein increased detection of early-stage hepatocellular carcinoma from 45% with ultrasound alone to 63% using the two tests in combination.” The study was published on February 6, 2018, in the journal Gastroenterology.
UT Southwestern Medical Center