A retrospective study on the patterns of sequential fluctuation of serum alpha‐fetoprotein level during progression from liver cirrhosis to hepatocellular carcinoma

The patterns of sequential fluctuation of serum alpha-fetoprotein levels were analysed in 218 patients with liver cirrhosis in whom the serum alpha-fetoprotein levels were regularly and serially measured for more than 1 year. In the group of patients with persistently abnormal high values (greater than 50 ng/mL) over a follow-up period of more than 1 year, the incidence of the subsequent development of hepatocellular carcinoma was statistically and significantly higher (44%) compared to the other groups which showed normal (less than 20 ng/mL) or low abnormal levels (21-50 ng/mL) (16%), and transient abnormal high levels (greater than 50 ng/mL for a period of less than 1 year, mostly within 5 months) or fluctuated repeatedly between normal and transient abnormal high levels (23%). Hepatocellular carcinoma developed in 48 patients more than 2 years after the diagnosis of liver cirrhosis, and the fluctuating patterns of serum alpha-fetoprotein levels were analysed in these patients. The serum alpha-fetoprotein levels in 10 of these 48 patients stayed below 50 ng/mL until about 2.0-10.0 months before the detection of hepatocellular carcinoma and then increased steadily until the time of hepatocellular carcinoma detection. In these 10 patients, the monthly increasing ratios were approximately 1.6-4.8 times the previous values.