The Evolution of the Use of Serum Alpha-fetoprotein in Clinical Liver Cancer Surveillance

Abstract

Liver cancer is the 6^th most common cancer and 2^nd leading cause of cancer-related mortality. In order to improve patient survival early tumor detection is required and this necessitates accurate screening of at risk individuals. In this article we concisely review the methodologies employed for Hepatocellular Carcinoma (HCC) surveillance and how their use has evolved over the last three decades. We focus attention to serum biomarkers, particularly alpha-fetoprotein. We propose that by using an increasingly sophisticated approach to assess dynamic rates of change in biomarkers tailored to individual patients that screening accuracy may be improved. Additional improvements may also be possible by the incorporation of patient clinical data into such personalised screening assessments. These possibilities may hold the promise of improving cancer detection and early curative therapy for the increasing worldwide population at risk of HCC development.

Keywords: Alphafetoprotein; Cancer screening; Hepatocellular carcinoma.

Figure 1

Timeline of HCC surveillance guidelines. Guidance from: BSG: British Society of Gastroenterology [7], AASLD: American Association for the Study of Liver Disease [14], APASL: Asian Pacific Association for the Study of the Liver [15], Canadian Multidisciplinary Guideline [16], EASL: European Association for the Study of the Liver, EORTC: European Organisation for Research and Treatment of Cancer [12], JSH: Japanese Society of Hepatology [17], NICE: National Institute for Health and Care Excellence, UK [18], NCCN: National Comprehensive Cancer Network, Guidelines Hepatobiliary Cancers [19].