Correlation of serum alpha fetoprotein (AFP) and tumor size of hepatocellular carcinoma (HCC) in a tertiary care hospital of Peshawar

Abstract

Introduction: Early diagnosis of Hepatocellular Carcinoma (HCC) by imaging and biochemical tests would be valuable in controlling morbidity and mortality associated with this most common primary hepatic malignancy which is the third leading cause of global cancer-related deaths. Objective: To determine an association between the level of serum Alpha Fetoprotein (AFP) and the size of the tumor in Hepatocellular Carcinoma (HCC).
Materials & Methods: This cross-sectional descriptive study was conducted in Rehman Medical Institute, Peshawar, Pakistan from January 2018 till December 2019. Data were gathered from the medical records of Endoscopy Unit of Rehman Medical Institute. Patients were separated into three groups on the basis of serum AFP levels: Group I had standard levels of AFP (<20 IU/ml), Group II had moderately raised AFP (20-399 IU/ml), and Group III had significantly raised AFP (>400 IU/ml). Patients were also separated into three groups on the basis of tumor; in Group A tumor size was less than 3 cm, in Group B it was between 3 and 5 cm, and in Group C the size was greater than 5 cm. For categorical variables, the Chi-square and Z test for proportions were applied; the Wilcoxon Rank-Sum (Mann-Whitney) test was used to evaluate the variation in the two categories, and the Kruskal-Wallis Rank test was used to evaluate the difference between categories. A p value <=0.05 was taken as significant. Descriptive statistics were obtained by SPSS 24. Result: A total of 136 patients were evaluated according to AFP levels. The male to female ratio was 2.31:1. The mean presenting age was 59.36 ± 9.85 years while the mean tumor size was 6.93 ± 4.39 cm. Regarding AFP groups, there were 50(36.76%), in Group I, 31(22.79%) in Group II and 38(27.94%) in Group III. As per the Child Pugh classification, Class A, B and C were 69.85%, 16.18% and 0% respectively.
Conclusion: Serum alpha fetoprotein was significantly associated with HCC tumor size. Alpha fetoprotein level can be a helpful marker to detect HCC and to differentiate between its initial and late stages. Monitoring AFP levels could be useful to diagnose recurring disease for patients with tumors that produce AFP.
Keywords: Serum Alpha Fetoprotein; Hepatocellular Carcinoma; Tumor size.