fetoprotein (AFP)
is a tumor marker of hepatocellular carcinoma (HCC) and has also
been reported to reflect the effectiveness of long-term low-dose
interferon (IFN) therapy in hepatitis C virus (HCV)-infected
patients with chronic liver disease. The correlation between AFP
levels and the incidence of HCC has been discussed over a long
period. We investigated whether high levels of AFP at the time of
diagnosis were associated with an increased incidence of HCC in
patients with HCV. A total of 107 HCV patients with liver
cirrhosis without other risks were evaluated for the predictive
value of non-invasive risk factors for HCC, including age, gender,
alcohol intake, aspartate and alanine aminotransferase levels,
bilirubin, albumin, platelet count and AFP levels at study entry,
as well as the IFN therapy received. During the follow-up period,
HCC developed in 68 (63.6%) patients. Kaplan-Meier estimates were
made to assess the cumulative risk of HCC. The 10-year cumulative
incidence rate of HCC was 80%. Cox regression analysis was
performed on several variables, including age, gender, alcohol
consumption, experience of IFN therapy and biochemical parameters.
The following factors were identified as exhibiting an increased
risk of HCC by univariate analysis: aspartate transaminase (AST)
≥71 IU/l, alanine transaminase (ALT) ≥60 IU/l, AFP ≥6 ng/ml and
IFN therapy. Multivariate analysis identified that the AFP level
[6-19 ng/ml: hazard ratio (HR), 2.22; P=0.006 and ≥20 ng/ml: HR,
2.09; P=0.003] was an independent and significant risk factor for
the development of HCC. A slightly elevated (6-19 ng/ml) AFP level
may be a risk factor for HCC in certain cases. By contrast, AFP
levels <6 ng/ml indicate a low risk of HCC development in HCV
patients with liver cirrhosis. |