Clinical significance of serum alpha-fetoprotein in patients with liver cirrhosis.

The clinical significance of serum alpha-fetoprotein (AFP) was studied in 114 patients with liver cirrhosis, who were followed for more than one year. Out of 114 patients, serum HBs antigen (HBsAg) was positive in 49 (43%). The mean follow-up period was 4.3 years (from 1 to 13 years). Serial determinations of AFP by RIA were performed once a month in all patients. The pattern of serial changes of AFP levels could be divided into three characteristic types: 1) fluctuation of AFP levels to greater than 20ng/ml was observed in 39 cases (Type I); 2) a transient rise of AFP levels to greater than 50ng/ml was observed in 20 cases (Type II); 3) in the remaining 55 cases, AFP levels were always less than 20ng/ml. During the follow-up period, liver cell carcinoma (LCC) developed in 29 cases (25%) and hepatic failure in 11 cases (10%). The incidence of LCC was significantly higher in Type I (18/39, 46%) than in Type II (3/20, 15%) and Type III (8/55, 15%). It is concluded that cirrhotic patients with fluctuation of AFP levels should be included in the high-risk group for LCC.