HCC : O-013 ; The factors influencing elevated serum alpha-fetoprotein levels in hepatitis B virus related cirrhosis without hepatocellular carcinoma

Background: Alpha-fetoprotein (AFP) is the most commonly used HCC biomarker, but recently their diagnostic limitation for detecting HCC has been debated. AFP elevation is commonly noted in chronic hepatitis B virus (HBV) infection without HCC, but the factors associated with elevated AFP is not well known in this group. The aim of this study was to determine the factors influencing elevated AFP other than HCC development in HBV associated cirrhosis patients Methods: This retrospective study included all consecutive patients with HBV related cirrhosis who visited our liver clinic from May 2003 to December 2010. Surveillance for HCC was performed by AFP and ultrasound examination every 3-6 months. Factors associated with maximum AFP (maxAFP) levels were assessed by univariate and multivariate logistic regression analysis and ROC calculation in order to elucidate the possible determinants of false-positive AFP tests . Results: Total 561 patients were enrolled, and HCC developed in 83 patients during mean follow-up of 50.4 months. Mean maxAFP level was 478 ng/ml in HCC group and 54 ng/ml in non-HCC group. The sensitivity and specificity of maxAFP > 37 ng/ml in diagnosing HCC were 58% and 82% with highest AUC of 0.758 and 35.8% and 91.8% of positive and negative predictive value, respectively. In univariate analysis, elevated AFP in non-HCC group was associated with higher initial ALT, PT(INR), HBV DNA level, lower albumin level and HBeAg positivity. By logistic regression analysis, AFP level >37 ng/ml was significantly associated with elevated PT(INR) and HBV DNA level, and AFP level > 100 ng/ml was significantly associated with only elevated HBV DNA level (HR=1.967, p=0.003). Conclusions: In HBV-related cirrhosis patients without HCC, serum AFP level is affected by serum HBV DNA levels. Thus, serum HBV DNA levels should be considered in assessing elevated AFP level in HBV related chronic liver disease patients.