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Evaluation of alpha-fetoprotein in detecting hepatocellular carcinoma recurrence after radiofrequency ablation

Authors

  • Surachate Siripongsakun,

    1. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    2. Department of Radiology, Chalubhorn Hospital, Bangkok, Thailand
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  • Sindy H Wei,

    1. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • Stephanie Lin,

    1. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • Jeffrey Chen,

    1. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • Steven S Raman,

    1. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • James Sayre,

    1. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    2. School of Public Health, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • Myron J Tong,

    1. Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    2. The Liver Center, Huntington Medical Research Institutes, Pasadena, California, USA
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  • David S Lu

    Corresponding author
    1. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    2. Pfleger Liver Institute and the Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    • Correspondence

      David S Lu, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. Email: dlu@mednet.ucla.edu

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  • Conflict of interest: Nothing to report.
  • Financial support: Nothing to report.
  • Author contributions:
  • Surachate Siripongsakun1,2,3,4,5, Sindy H. Wei2,4, Stephanie Lin2, Jeffrey M. Chen2, Steven Raman1,4, James Sayre3, Myron J. Tong1,3,5, David S. Lu1,3,4,5
  • Note: 1.Study concept and design 2.Acquisition of data 3.Analysis and interpretation of data 4.Drafting the manuscript 5.Critical revision of the manuscript.

Abstract

Background and Aim

The performance of alpha-fetoprotein (AFP) in the detection of hepatocellular carcinoma (HCC) recurrence after radiofrequency ablation was analyzed.

Methods

One hundred and forty-six solitary HCC lesions treated by radiofrequency ablation were evaluated. Using the AFP cutoff level at ≥ 20 ng/mL, tumors were categorized into AFP or non-AFP-producing HCC. Factors associated with true and false interpretations for cancer recurrence including analysis of elevated alanine aminotransferase (ALT) were evaluated. The performance of AFP using different cutoff levels adjusted for abnormal ALT was compared.

Results

Of 146 HCCs, 103 demonstrated no HCC recurrence while 43 had local recurrence. In non-recurrence HCC cases, increased AFP levels (false positive) were associated with concomitant ALT elevations, while those with normal AFP (true negative) had correspondingly normal ALT values (P < 0.001). The AFP false positive rate in cases of elevated ALT was significantly higher than those with normal ALT levels (31.9% vs 5.4%, P = 0.001). Among all positive AFP tests, those with false positive values (non-recurrence) had a significantly lower AFP level than the true positive (recurrence) HCC cases (39.8 ng/mL vs 372 ng/mL, P < 0.001).

At the 20 ng/mL cutoff level, the sensitivities of AFP for detecting recurrence in non-AFP-producing HCC and AFP-producing HCC were 12.0%, and 72.2%, respectively. Using a modified AFP criteria of ≥ 100 ng/mL for cases where ALT ≥ 40 U/L, the sensitivity and specificity in AFP-producing tumors increased from 72.2% and 56% to 100% and 85%, respectively.

Conclusion

Serum AFP is a useful test in the detection of HCC recurrence in AFP-producing HCC. The performance in AFP-producing HCC was significantly improved after adjusting for elevation of serum ALT.

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