Narrating Review Of Alfa-Fetoprotein As A Tumour Marker Of Liver Cancer In Hepatocellular Carcinoma (HCC)

Abstract

Background: Alpha fetoprotein (AFP) is produce by fetal liver and yolk sac , which normally decreases after birth. It is a glycolprotein. However, increased serum AFP levels in adults are linked  with hepatocellular carcinoma (HCC) and other malignancies. One of the most common liver cancer is Hepatocellular carcinoma (HCC) around the world, often detect at an grow stage due to its asymptomatic early course. Despite AFP’s widespread use as a tumor marker, its diagnostic accuracy varies, normal AFP level and some chronic liver disease despite confirmed HCC. This study focuses on evaluating the diagnostic role of AFP as a tumor marker for liver cancer in patients with HCC.

Objective(s): Alpha^_Fetoprotein (AFP) as a tumor marker of liver cancer in Hepatocellular carcinoma (HCC)  .

Methodology: This is a one time study, laboratory-based study will be perfome at the Department of Pathology and Radiology, Social Security Teaching Hospital, Lahore, over four months (June–September 2025). A total of 96 patients clinically or radiologically suspected of HCC will be enrolled using non-probability purposive sampling. Blood samples will be collected for AFP estimation using a Chemiluminescent Immunoassay (CLIA) or ELISA method on an automated immunoassay analyzer (e.g., Architect i2000). Radiological imaging (ultrasound, CT, or MRI) will confirm tumor presence. Data will be analyzed using SPSS, with descriptive and inferential statistics applied. Diagnostic performance (sensitivity, specificity, PPV, NPV, ROC analysis) will be determined, with p < 0.05 look at statistically important.

Results: From 202 liver disease cases analyzed in referenced literature, AFP positivity was found in 45.8% of HCC patients, while cirrhosis, chronic liver disease, and control groups showed no detectable AFP levels. HBV and HCV infacted at the same time cases showed the highest AFP positivity (85.7%), followed by HBV alone (62.9%), aflatoxin B1 positive cases (54.5%), and HCV alone (17.6%). The average age of HCC patients for female is 46 year and for male is 62 year. Elevated AFP levels (≥20 ng/mL) were significantly associated with HCC diagnosis confirmed by imaging.

Conclusion(s): Alpha-fetoprotein remains a valuable and accessible biomarker for diagnosing and monitoring hepatocellular carcinoma, particularly in HBV-associated cases. However, its diagnostic sensitivity is limited in HCV-related or AFP-negative HCC, emphasizing the need for combining AFP testing with advanced imaging modalities and other novel biological indicator for early findings and better prognosis the liver cancer.