Hepatocellular carcinomas 1 cm in diameter with high or low echogenicity can be detected on ultrasonography and confirmed on fine-needle biopsy, but it is still very difficult to detect small hepatocellular carcinomas with isoechogenicity. In this study, we assessed lymphokine-activated killer cell activity and interferon-y production prospectively every 1 to 3 mo for 23 -C 4 mo (mean f 1 S.D.) in 227 patients with cirrhosis. Transient depression of lymphokine-activated killer activity was detected in 43 patients (defective lymphokine-activated killer group), and hepatocellular carcinoma was detected in 24 cases before the end of the 18-mo follow-up. Twenty-one (87.5%) of the 24 hepatocellular carcinoma patients were included in the defective lymphokine-activated killer group. Defective lymphokine-activated killer activity was detected more than 6 mo before detection of a space occupying lesion in the liver or elevation of a-fetoprotein level above 400 ng/ml. Serum a-fetoprotein level was elevated above 400 ng/ml in only five cases in which hepatocellular carcinoma was detected as a spaceoccupying lesion. Our results indicate that sequential assessment of lymphokine-activated killer activity may be a predictor of hepatocellular carcinoma and that the depression of immune function in cirrhotic patients is a serious risk factor for hepatocellular carcinoma emergence. (HEPATOLOGY 1993; 18:3 15-3 19.) HCC is one of the most common malignant tumors in Japan. Patients with cirrhosis are considered to be at high risk of HCC because 76% of HCCs are associated with cirrhosis (1). Computed tomography and ultrasonography (US) are the major detectors of HCC. An HCC 1 cm in diameter with high or low echogenicity can be detected on US and confirmed on needle biopsy. However, it is still very difficult to detect a small HCC with isoechogenicity . Serum a-fetoprotein (AFP) level more than 400 ng/ml is a marker of HCC (2-4); however, it is not sufficiently sensitive to detect a small HCC (3,