Effect of antiviral treatment on AFP levels in HBV-related cirrhotic patients:

liver411

early detection of HCC

<http://www3.interscience.wiley.com/journal/122634712/abstract>

Journal of Viral Hepatitis
Volume 17 Issue 7, Pages 511 - 517
Published Online: 8 Oct 2009
© 2010 Blackwell Publishing Ltd


Effect of antiviral treatment on alfa-fetoprotein levels in HBV-related
cirrhotic patients: early detection of hepatocellular carcinoma

K. Luo 1 , Z. Liu 1 and P. Karayiannis 2

1 Department of Infectious Diseases and Hepatology Center, Nanfang Hospital,
Southern Medical University, Guangzhou, China ; and   2 Department of
Medicine, Imperial College, London, UK
Correspondence to Kangxian Luo, North Guangzhou Avenue 1838#, Department of
Infectious Diseases and Hepatology Center, Nanfang Hospital, Southern Medical
University, Guangzhou, 510515, China. E-mail: [email protected]
Copyright © 2010 Blackwell Publishing Ltd

ABSTRACT
Summary. Alpha-fetoprotein (AFP) is a marker of the presence of hepatocellular
carcinoma (HCC), but is also elevated in advanced chronic hepatitis B. The
detection and usage of AFP tests need to be improved. A cohort of 101 patients
with advanced chronic hepatitis B and elevated AFP values was treated with
entecavir (ETV) or peginterferon-α2a. ETV was more effective in reducing AFP
levels; mean time to AFP normalization was 11.9 weeks after ETV treatment
initiation vs 22.3 weeks in peginterferon treated patients (P = 0.000). An
additional cohort of 93 hepatitis B virus (HBV) cirrhotic patients with
elevated AFP were treated with ETV prospectively and maintained under
intensive surveillance. HCC developed in 16 (17.2%) patients in whom the
strongest independent predictor was a continued AFP rise in spite of ongoing
treatment. In this context, nodules of sizes 10-14 mm and 15-20 mm were
detected in 40% of patients each. In conclusion, HBV cirrhotic patients with
rising AFP levels were at very high risk of HCC development. Early detection
of minute lesions may be possible by monitoring AFP levels, whilst patients
are on treatment in conjunction with enhanced computed tomography examination.

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Received April 2009; accepted for publication July 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1365-2893.2009.01208
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