α-Fetoprotein, Des-γ Carboxyprothrombin, and Lectin-Bound α-Fetoprotein in Early Hepatocellular Carcinoma

Marrero, Jorge A.; Feng, Ziding; Wang, Yinghui; Nguyen, Mindie H.; Befeler, Alex S.; Roberts, Lewis R.; Reddy, K. Rajender; Harnois, Denise M.; Llovet, Josep M.; Normolle, Daniel P.; Dalhgren, Jackie; Chia, David; Lok, Anna S.; Wagner, Paul D.; Srivastava, Sudhir; Schwartz, Myron

doi:10.1053/j.gastro.2009.04.005

Cited by 645 publications

(573 citation statements)

References 24 publications

(29 reference statements)

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“…In patients with high levels of tumor markers, complete resection Nanashima et al, Page 5 or necrosis of HCC should result in normalization of tumor markers within the half life of these markers, only a couple of days (14,16). A few reports, including our preliminary studies, indicated that changes of serum levels of AFP and PIVKA-II correlate with prognosis (14,17,18). However, to date, there is no consensus regarding the value of post-treatment evaluation of tumor markers.…”

Section: Introductionmentioning

confidence: 99%

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

et al. 2011

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Abstract-fetoprotein (AFP) is used as a marker for hepatocellular carcinoma (HCC), which is influenced by hepatitis. Protein induced vitamin K absence or antagonist II (PIVKA-II) is a sensitive diagnostic marker. Changes in these markers after treatment may reflect curability and predict outcome. We conducted an analysis of prognosis in 470 HCC patients who received curative treatments, and examined relationship between changes in AFP and PIVKA-II levels after 1-month of treatment in 156 patients. Subjects were divided into three groups according to changes in both levels: 1) normal (L) group before treatment, 2) normalization (N) or 3) decreased but still above normal level or unchanged (ANU) group after treatment. High AFP and PIVKA-II levels were significantly associated with poor tumor-free and overall survival. Presence of large size and advanced stage were significantly associated with prevalence of DU group. Overall survival in the AFP-L group was significantly better than those of other groups and overall survival in PIVKA-II-L and N groups were significantly better than those of PIVKA-II-ANU groups. Combination of changes in AFP-ANU and PIVKA-II-ANU group showed the worst tumor-free and overall survivals. Multivariate analysis identified high pre-treatment levels of AFP and PIVKA-II and combination of AFP-ANU and PIVKA-II-ANU as significant determinants of poor tumor-free and overall survival, particularly in patients who underwent hepatectomy. We conclude that high levels of AFP or PIVKA-II after treatment for HCC did not sufficiently reflect curative efficacy of treatment and reflected a poor predictor of prognosis in HCC patients. Nanashima et al., Page 3

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Section: Introductionmentioning

confidence: 99%

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

et al. 2011

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“…Specific HCC markers, such as PIVKA-II or AFP levels, are commonly used in Japan for the diagnosis of HCC or for the evaluation of tumor aggressiveness [19][20][21][22][23]. It has been reported that high values of these preoperative markers reflect the prognosis for HCC patients who undergo hepatectomy [24].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Serum Hyaluronic Acid Level and Patient Prognosis in Hepatocellular Carcinoma Patients Who Underwent Hepatectomy

Nanashima¹,

Abo²,

Murakami³

et al. 2013

JCT

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We examined the relationship between hyaluronic acid (HA) and tumor-related factors after hepatectomy in 158 patients with hepatocellular carcinoma (HCC) who underwent hepatectomy. We examined serum HA levels before hepatectomy by evaluating data for clinicopathological parameters, surgical records, postoperative complications and survival. The mean HA level was 190 ± 202 ng/ml. Patients were divided into 3 groups: group A had serum HA levels less than 50 ng/ml (normal range), group B had levels between 50 and 190 ng/ml, and group C had levels over 190 ng/ml. Group C had a higher rate of poor liver function compared to others. Multiple tumors were significantly more frequent in groups B and C compared to A. The grade of fibrosis and the inflammatory responses were positively correlated with the serum HA level. Postoperative long-term ascites was significantly more frequent in group C compared to others. Although the recurrence rate and the relapse-free period were not significantly related to the serum HA level, the serum HA level was significantly associated with overall survival after hepatectomy (p < 0.05). Cox's multivariate analysis did not show a significant relationship between HA level and survival. Serum HA reflects progression and survival in HCC patients.

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“…Tumor markers could be a useful tool to overcome theoretical limitations of US: its evaluation is not subjective, does not depend on the operator and it may be reproducible, as well as it is relatively cheap and a tool easy to access in areas with low monetary income. Regrettably, different tumor markers evaluated in early stage HCC scenario have shown a low diagnostic accuracy (10)(11)(12)(13) and its association with ultrasonography does not improve its performance and increases the cost of screening programs (14). A recent study has proposed a microRNA panel detected in plasma samples for the early diagnosis, but there is a need of external validation of its efficacy (15).…”

Section: Improving Early Diagnosismentioning

confidence: 99%

New challenges in clinical research on hepatocellular carcinoma

Díaz-González¹,

Forner²,

C³

et al. 2015

Rev Esp Enferm Dig

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This is an updated review of screening, early diagnosis and treatment of hepatocellular carcinoma, focusing on the advancements occurred in the last years and highlighting the challenges in clinical research.Hepatocellular carcinoma (HCC) is nowadays the sixth most frequent cancer worldwide with up to 740,000 new cases diagnosed each year, and it is the third most prevalent cause of cancer-relateddeath worldwide (1). This neoplasm usually appears linked to an underlying liver disease, being one of the most relevant causes of death in patients diagnosed of liver cirrhosis (2,3). In the last years, important advancements in terms of diagnosis, staging and treatment of HCC, improving the management and outcome of the disease, have been made (4-7). Despite the fact that these improvements have absolutely changed natural history of HCC, there are several areas that still need further advancements.The aim of this document is to discuss some controversial aspects, which in our opinion constitute real challenges in clinical research of HCC.Key words: Hepatocellular carcinoma. Hepatic oncology. Sorafenib. Transarterial chemoembolization. AFP. IMPROVING EARLY DIAGNOSISFrom the basis that the only possibility to offer and apply treatments with curative intention is being able to diagnose HCC at early stages, when there are not cancer related symptoms. Since this option is only feasible if screening is performed in population at risk, scientific guidelines recommend performing abdominal ultrasonography (US) in every patient with liver cirrhosis. Despite the recommendation of HCC screening by the Spanish guidelines (4), one registry study performed in Spain which included 62 centers and 705 patients diagnosed of HCC within a period of time of 4 months showed that just 47% of HCC patients were diagnosed in the setting of surveillance and less than a half were diagnosed at early stage (8).This data shows that early diagnosis, a key issue to be able to significantly reduce HCC-related mortality, is one of the most relevant issues that deserve further efforts from scientific community. Aiming to evaluate which were the causes of screening program fail in the United States of America, Singal et al. evaluated 1,005 patients included in the HALT-C prospective study. A third part of patients did not adhere to an adequate screening program and, in 70% of cases that were diagnosed at an advanced stage, the main reason was the absence of detection in US (9).With the aim of improving detection rate, it is crucial to establish formative programs in order to certify the capability of being able to carry on this activity and it is necessary to use up-to-date ultrasonography scans in order to perform an optimal liver exploration. Tumor markers could be a useful tool to overcome theoretical limitations of US: its evaluation is not subjective, does not depend on the operator and it may be reproducible, as well as it is relatively cheap and a tool easy to access in areas with low monetary income. Regrettably, different tumor markers ev...

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α-Fetoprotein, Des-γ Carboxyprothrombin, and Lectin-Bound α-Fetoprotein in Early Hepatocellular Carcinoma

Cited by 645 publications

References 24 publications

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

Tumor Marker Levels Before and After Curative Treatment of Hepatocellular Carcinoma as Predictors of Patient Survival

Relationship between Serum Hyaluronic Acid Level and Patient Prognosis in Hepatocellular Carcinoma Patients Who Underwent Hepatectomy

New challenges in clinical research on hepatocellular carcinoma

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