The usefulness of measurements of serum a-fetoprotein elevation for diagnosis of the development of hepatocellular carcinoma was evaluated by a prospective study of 260 patients with cirrhosis. Hepatocellular carcinoma was found in 55 patients during the 5-yr follow-up, excluding 7 found to have hepatocellular carcinoma in the first 6 mo. The cumulative incidence of hepatocellular carcinoma was 26% in the 185 patients who had a-fetoprotein levels below 20 ng/ml at the time of entry and 46% in the 68 patients who had a-fetoprotein levels of 20 n g / d or more but below 200 ng/ml. In 169 of the patients, serum levels of a-fetoprotein were assayed regularly for at least 2 yr. The incidence of hepatocellular carcinoma development in the 36 patients who had repeated transient increases in a-fetoprotein to above 100 n g / d was 36%.
This was significantly higher than the incidence in the 99 patients who had a-fetoprotein levels consistently below 20 ng/ml. Thus patients who had a-fetoprotein levels of 20 n g / d or more, who had transient increases in a-fetoprotein or who had both should be treated as being in a super-high-risk group for hepatocellular carcinoma. Frequent and careful examination by ultrasonography of such patients is recommended. (HEPATOLOGY 1994;1961-66.) The incidence of HCC in subjects with cirrhosis is high, and the early diagnosis of HCC is of clinical importance. Serum levels of cY-fetoprotein (AFP) have been measured for use in the diagnosis of advanced HCC, but imaging techniques make it possible now to detect small HCCs in patients whose serum level of AFP may be within the normal range. Serum AFP is sometimes high in patients with cirrhosis without HCC ( 1 , Z ) . Thus AFP measurement is not very useful for the early diagnosis of HCC. Colombo et al.
(3) report that the risk of HCC is low when the level of AFP is 20 ng/ml or less and suggest that frequent monitoring of AFP is unnecessary in such patients.
Lehmann and Wegener (4) have pointed out the