Tumor Markers for Hepatocellular Carcinoma: Simple and Significant Predictors of Outcome in Patients with HCC

Abstract

Background: The effectiveness of tumor markers in evaluating outcomes of patients with hepatocellular carcinoma (HCC) remains to be clarified. Summary: The usefulness of the HCC tumor markers, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3), and des-gamma-carboxy prothrombin (DCP) was reviewed. Elevations in these tumor markers at the time of HCC diagnosis correlate with disease progression as assessed by both imaging studies and pathologic examinations. The combination of these three tumor markers results in good predictive ability for patient survival after diagnosis. In addition, combination at the time of HCC diagnosis of these three tumor markers (as a measure of tumor progression) and serum albumin and bilirubin levels (as indicators of remnant liver function) can be used for HCC staging and further predicts prognosis in patients with HCC. Key Message: The prognosis of patients with HCC can be well discriminated based solely on serum markers. Staging of HCC with serum markers is objective; if stored serum samples are available, HCC stages can be standardized across different countries and time periods.

Real-Life Clinical Practice with Sorafenib in Advanced Hepatocellular Carcinoma: A Single-Center Experience Second Analysis

“…In a previous study, we reported that the duration of administration was a significant prognostic factor for sorafenib treatment. A blood chemical test related to liver functions, such as serum levels of bilirubin as well as the tumor markers alpha-fetoprotein (AFP) and des-gamma carboxyprothrombin (DCP), could also be a marker predicting an overall survival (OS) [31,32,33,34]. In the current study, we retrospectively investigated 356 HCC patients treated with sorafenib at the Kinki University Hospital to elucidate the efficacy of sorafenib treatment and the clinical outcomes.…”

General Rules for the Clinical and Pathological Study of Primary Liver Cancer, Nationwide Follow-Up Survey and Clinical Practice Guidelines: The Outstanding Achievements of the Liver Cancer Study Group of Japan

“…Evidence levels and recommended grades are listed to assist the diagnosis and treatment of HCC in daily clinical practice. The surveillance and diagnostic algorithm, the most important part of the clinical practice guidelines, recommends regular ultrasound and tumor marker screening using 3 markers (AFP, AFP-L3 and PIVKA-II) [31,32,33] or annual-to-semiannual CT or MRI depending on whether the patients are categorized as very high-risk or high-risk patients. The treatment algorithm presents treatment strategies that are in line with the severity of liver damage and the number and size of tumors [8,9].…”

Challenges of Clinical Research on Hepatocellular Carcinoma

“…In Japan, prothrombin induced by vitamin K absence-II (PIVKA-II), and the L3 fraction of AFP (AFP-L3) [2,3,4] are routinely used alongside AFP to screen for HCC. However, in other countries, the clinical guidelines for HCC, such as those issued by the American Association for the Study of Liver Diseases (AASLD) [5] and the European Association for the Study of the Liver (EASL) [6], do not recommend the use of PIVKA-II or AFP-L3 in daily clinical practice.…”

“…AFP-L3 does not correlate with AFP or PIVKA-II in patients with HCC [2,4]. In recent years, the measurement of highly sensitive AFP-L3 has been attracting attention because this innovative method enables AFP-L3 to be measured even when total AFP levels are ≤10 ng/ml.…”

“…stages I and II), making the marker useful in the early diagnosis of HCC [20,21]. The malignancy rate of AFP-L3-positive liver cancer is extremely high, and while the survival of AFP-L3-negative patients who had high AFP-L3 levels before treatment is similar to the survival of patients negative for AFP-L3 throughout treatment, and the survival of patients who maintain high AFP-L3 levels even after treatment is significantly poor [4,22]. …”