Prognostic Value of Serum AFP in HCCEgyptian Patients

Abstract

HCCrepresentsmorethan90%ofprimarylivercancersandisamajorglobalhealthproblem.Itsincidenceisincreasing,rangingbetween3%and9%annuallydependingonthegeographicallocationandvariabilityintheincidenceratescorrespondcloselytotheprevalenceandpatternoftheprimaryetiologicfactors. Alpha-fetoproteinisaglycoproteincomprisedof591aminoacidswithahalf-lifeof5-7days.Normallyproducedbythefoetalyolksac,liver,andintestine,elevatedlevelscanbeassociatedwithHCCintheappropriateclinicalsetting.HighAFPserumlevelshavebeenfoundin60-70%ofpatientswithHCC;nevertheless,thereareothercausesofincreasedlevels,suchascirrhosis,lungcancer,biliarycancer,gastriccancer,pancreaticcancer,teratocarcinomaofthetestis,spherocytosisandtyrosinemia. TheaimofthepresentworkwastostudytheprognosticvalueofserumAFPinpatientswithHCCinEgypt. ThisstudywasconductedatTropicalMedicinedepartmentandHCCclinic,AinShamsUniversityHospitals.ConsecutivepatientswithHCCseenintheoutpatientclinicofHCCUnit,AinShamsUniversityHospitals,Cairo,Egypt,orthoseHCCinpatientsadmittedtotheTropicalMedicineDepartment,AinShamsUniversityHospitals,wereenrolledintoadatabasethatwasapprovedbytheInstitutionalReviewBoard. All patients with diagnosed HCC who underwent interventions between January 2009 and December 2012 were reviewed and the data of those patients who fulfilled the inclusion criteria was retrospectively retrieved from the files of patients. Minimumdatasetwithinthepatientrecordwithafollow-upperiodofatleast1yearwaspredefinedbeforecollectionofdatatoincludearecordinthisretrospectivestudy.ThisstudywasconformedtothestandardsoftheDeclarationofHelsinkiandcurrentethicalguidelinesandwasapprovedbytheResearchandEthicsCommitteeofAinShamsUniversity,Cairo,Egyptinaccordancewithlocalresearchgovernancerequirements. Inclusioncriteria: 1- ProveddiagnosisofHCCaccordingtoAASLDpracticeguidelines(BruixandSherman,2005,2011). 2- Patients underwent any intervention for HCC according to BCLC (The BarcelonaClinicLiverCancer staging system). 3- The enrolled patients had been followed up till death or till the end of the study.

Exclusion criteria: 1- ChildclassCpatientsorBCLCstage C or D. 2- Patientswholostfollowupor did not complete a minimum follow-up period of 1 year. 3- Anyothermedicalco-morbiditiesas(heartfailure,renalfailure,respiratoryfailure,…) Allthepatientsweresubjectedto: 1. Fullpersonalhistorytaking. 2. Thoroughclinicalexamination. 3. Laboratoryinvestigationsincluding: Completebloodpicture,liverprofile(serum albumin, serum bilirubin and prothrombintime)kidneyfunctiontests(serumcreatinine,blood),viralmarkers(HCV and HBsAg)andAFP. 4. Ultrasoundtodetectthehepaticfocallesion 5. Triphasicpelvi-abdominalCTtodiagnoseHCC 6. Liverbiopsyifindicated

AFP levels were recorded for all patients at the time of diagnosis, after any intervention whether surgical or locoregional and at 3 month interval afterwards. Patients were stratified according to their level of AFP and the relation between AFP level and prognosis of HCC was studied.