PT  - JOURNAL ARTICLE
AU  - Gwilym J Webb
AU  - Kathryn VC Wright
AU  - Elizabeth CB Harrod
AU  - David A Gorard
AU  - Jane D Collier
AU  - Alexander KC Evans
TI  - Surveillance for hepatocellular carcinoma in a mixed-aetiology UK cohort with cirrhosis: does α-fetoprotein still have a role?
AID  - 10.7861/clinmedicine.15-2-139
DP  - 2015 Apr 01
TA  - Clinical Medicine
PG  - 139--144
VI  - 15
IP  - 2
4099  - http://www.rcpjournals.org/content/15/2/139.short
4100  - http://www.rcpjournals.org/content/15/2/139.full
SO  - Clin Med2015 Apr 01; 15
AB  - Mortality from hepatocellular carcinoma (HCC) in people with cirrhosis is increasing whereas mortality from other causes is declining. Surveillance appears to reduce mortality but the optimal strategy is uncertain. Current guidelines differ by recommending ultrasonography alone or with α-fetoprotein (αFP). Records in three UK hospitals were analysed from 2006 to 2011. Of 111 HCC cases identified, 24 (47.1%) of those eligible were under surveillance: 21 (87.5%) were under combined ultrasonography–αFP, 2 (8.3%) ultrasonography-only and 1 (4.2%) αFP-only surveillance. αFP was elevated in 19 (86.4%), and αFP alone triggered a confirmatory study in 11 (9.9%) overall and 7 (29.1%) under surveillance. Surveillance, but not αFP, correlated with smaller tumours. Survival did not differ significantly between groups. Given that αFP use is associated with identifying smaller HCCs and that several diagnoses would have been delayed without αFP in this real-life cohort, these data support ongoing αFP use. However, further work is necessary with regard to whether αFP translates into improved clinical outcome and overall cost effects. In our area, stopping αFP use would also represent a significant change in practice.