Serum α-fetoprotein (AFP) testing is no longer recommended for hepatocellular carcinoma (HCC) screening or diagnosis.1 However, AFP remains a valuable tool to monitor treatment response in the 60% to 75% of patients with AFP-producing tumors,1- 3 and as a prognostic marker for recurrence after a liver transplant (LT).4- 6 Although low or decreasing AFP levels at the time of LT predict a lower risk of recurrence, studies have not distinguished HCCs with low AFP levels as a result of cancer treatment from HCCs that do not produce AFP. Thus, it is uncertain whether conventional predictors of recurrence of HCC after LT extend to the subgroup of non-AFP–producing tumors, or whether the lack of AFP production indicates a distinct cancer behavior and prognosis.
Schlansky B, Orloff SL. Promise and Pitfalls of Using α-Fetoprotein in Liver Transplantation Allocation for Hepatocellular Carcinoma. JAMA Surg. Published online October 05, 2016. doi:10.1001/jamasurg.2016.3495