Low alpha-fetoprotein hepatocellular carcinoma

Background and Aim: A large proportion of hepatocellular carcinoma (HCC) patients do not secrete elevated levels of the tumor marker alpha-fetoprotein (AFP). There is little published guide to prognostic features of this patient subset. Methods: We interrogated a large HCC database in which all patients had been followed until death, to examine which features might be prognostically useful. Results: We found 413 biopsy-proven unresectable HCC patients with low serum AFP values. Serum gamma glutamyl transpeptidase (GGTP) levels were one of the most significant factors for survival. This dichotomization into low and high GGTP levels separated the patients into distinctive survival ranges. Patients with GGTP levels < 110 U/100 mL and small tumors had longest survival > 795 days. Patients with GGTP >= 110 U/mL and large tumors with the presence of portal vein thrombosis had the shortest survival range of 300-560 days. Conclusions: Serum levels of the onco-fetal protein GGTP represent a useful prognostic parameter in HCC patients with low AFP levels.