Among the 3,027 patients included in the Italian Liver Cancer study group database, we selected 205 Child-Pugh class A and Eastern Cooperative Group Performance Status 0 patients with cirrhosis with a single HCC ≤3 cm of diameter diagnosed during surveillance who were treated with curative intent (hepatic

resection, liver transplantation, percutaneous ethanol injection, radiofrequency thermal ablation). selleck screening library Patients were subdivided according to alpha-fetoprotein serum levels (i.e., normal ≤20 ng/mL; mildly elevated 21-200 ng/mL; markedly elevated >200 ng/mL). Patient survival, as assessed by the Kaplan-Meier method, was not significantly different among the three alpha-fetoprotein classes (P = 0.493). The same result was obtained in the subgroup of patients with a single HCC ≤2 cm (P = 0.714). An alpha-fetoprotein serum level of 100 ng/mL identified by receiver operating characteristic curve had inadequate accuracy (area under the curve = 0.536, 95% confidence interval = 0.465-0.606) to discriminate between survivors and deceased patients. Conclusion: Alpha-fetoprotein selleck kinase inhibitor serum levels have no prognostic meaning in well-compensated cirrhosis patients with single, small HCC treated with curative intent. (HEPATOLOGY 2012) Hepatocellular carcinoma (HCC) is the third cause of cancer death and the leading cause of mortality among patients with cirrhosis.1 Liver

cirrhosis is in fact the main risk factor for HCC, and the annual incidence see more of HCC in cirrhosis patients is 3%-7%.2, 3 Detecting HCC at an early stage is the main objective of screening and surveillance programs.3 Indeed, the utility of surveillance for HCC in patients with cirrhosis is supported by the results of a randomized trial carried out in patients with chronic hepatitis B virus (HBV) infection and several cohort studies performed in patients with cirrhosis.4-7 Surveillance of patients at risk of HCC with liver ultrasound, with or without serum alpha-fetoprotein assessment, is recommended by European, American, and Asiatic HCC

management guidelines with the aim to identify HCC at an early stage in those patients who, in the event of cancer detection, are amenable to curative therapies able to improve their prognosis.8-10 The American Association for the Study of Liver Diseases (AASLD) guidelines for HCC diagnosis and treatment, however, recently dropped alpha-fetoprotein assessment from the surveillance armamentarium due to poor sensitivity for early diagnosis of HCC and unacceptable specificity of this tumoral marker.10 Nonetheless, the use of alpha-fetoprotein as a prognostic indicator when HCC is diagnosed in the most favorable setting—patients with compensated cirrhosis, optimal performance status, single, small HCC, and as such amenable to curative treatment—has not been sufficiently addressed so far.