Reappraisal of serum alpha-foetoprotein as a surveillance test for hepatocellular carcinoma during entecavir treatment

Background & AimsThe aim of this study was to re-evaluate the diagnostic performance of alpha-foetoprotein (AFP) as a surveillance test for hepatocellular carcinoma (HCC) in patients with hepatitis B virus-related chronic liver disease who were treated with entecavir (ETV). MethodsBetween January 2007 and August 2012, we analysed 373 treatment-naive patients with HBV-related chronic hepatitis (n=229) or cirrhosis (n=144) who were candidates for surveillance test, and were treated with ETV (0.5mg/day) for longer than 12months. To minimize the effect of AFP elevation caused by hepatitis activity, serum AFP levels were measured 12months after the initiation of ETV treatment. ResultsHepatocellular carcinoma developed in 28 patients (7.5%) during a median follow-up period of 48.0months (IQR=40.5-57.3months). The area under the receiver operating characteristic curve for AFP was 0.71 (95% CI=0.59-0.84). The optimal AFP cut-off value was 13ng/ml, leading to a sensitivity of 50.0%, specificity of 98.8%, positive predictive value of 77.8% and negative predictive value of 96.1%. In multivariate Cox analysis, an older age, the presence of cirrhosis and AFP levels of 20ng/ml at 12months after treatment were found to be significantly associated with an increased incidence of HCC. ConclusionsThe role of serum AFP as a surveillance test should be re-evaluated in patients with HBV-related chronic liver diseases who were treated with antiviral therapy.