Update on the applications and limitations of alpha-fetoprotein for hepatocellular carcinoma

Alpha-fetoprotein (AFP) is an oncofetal glycoprotein that has been used as a tumor marker for hepatocellular carcinoma (HCC) in combination with ultrasound and other imaging modalities. Its utility is limited because of both low sensitivity and specificity, and discrepancies among the different meth...

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Published inWorld journal of gastroenterology : WJG Vol. 28; no. 2; pp. 216 - 229
Main Authors Hanif, Hira, Ali, Mukarram Jamat, Susheela, Ammu T, Khan, Iman Waheed, Luna-Cuadros, Maria Alejandra, Khan, Muzammil Muhammad, Lau, Daryl Tan-Yeung
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 14.01.2022
Subjects
alpha-Fetoproteins
Biomarkers, Tumor - genetics
Carcinoma, Hepatocellular - diagnostic imaging
Humans
Liver Cirrhosis
Liver Neoplasms - diagnostic imaging
Minireviews
Cirrhosis
Hepatocellular carcinoma
Alpha-fetoprotein-L3
Tumor markers
Hereditary persistence of alpha-fetoprotein
Alpha-fetoprotein
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Summary:Alpha-fetoprotein (AFP) is an oncofetal glycoprotein that has been used as a tumor marker for hepatocellular carcinoma (HCC) in combination with ultrasound and other imaging modalities. Its utility is limited because of both low sensitivity and specificity, and discrepancies among the different methods of measurements. Moreover, its accuracy varies according to patient characteristics and the AFP cut-off values used. Combination of AFP with novel biomarkers such as AFP-L3, Golgi specific membrane protein (GP73) and des-gamma-carboxyprothrombin significantly improved its accuracy in detecting HCC. Increased AFP level could also signify severity of hepatic destruction and subsequent regeneration and is commonly observed in patients with acute and chronic liver conditions and cirrhosis. Hereditary and other non-hepatic disorders can also cause AFP elevation.
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Author contributions: Hanif H and Ali MJ contributed equally; Lau DTY provided the concept and direction of the review, the learning points and the editing of the manuscript; Khan MM, Hanif H, Ali MJ, Susheela AT, and Luna-Cuadros MA reviewed the literature and wrote the first manuscript draft; Khan IW and Ali MJ contributed to the addition of literature, revision and edition of the final manuscript; Khan MM and Lau DTY are joint senior authors.
Corresponding author: Daryl Tan-Yeung Lau, MD, MSc, Associate Professor, Liver Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St. Liver Research Center, Suite 4A, Boston, MA 02215, United States. dlau@bidmc.harvard.edu
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v28.i2.216