Hepatocellular carcinoma (HCC) prognosis is related to the tumor stage and to the patient’s underlying liver function. Extrahepatic metastases are present in 13.5-42% of patients at the time of diagnosis. Our study pourpose is to determine the correlation of elevated serum Alpha fetoprotein (AFP) and the presence of metastatic disease detected by positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose with computed tomography (18F-FDG PET/CT) in patients affected by HCC.
62 patients were enrolled in this study; all patients were affected by chronic liver disease complicated by development of HCC. Complete blood count, liver function test, total protein, Albumin/Globulin (A/G) ratio, serum albumin, HBsAg, anti HCV, AFP, ultrasound guided liver biopsy, ultrasound and chest-abdomen CT scan for size and number of tumor were also performed.
On the basis of AFP levels, patients were divided into 3 groups; group I with normal AFP (<20 IU/ml), group II with moderately elevated AFP (20-399 IU/ml), and group III with markedly elevated AFP (>400 IU/ml). On the basis of presence of metastatic disease found at 18F-FDG PET/CT patients were also divided into 2 groups; group A without metastasis and group B with metastatic disease. Correlation of serum AFP levels with metastatic disease was analyzed by applying Spearman’s rank correlation with r-values of 0.01 being considered significant.
Revision of the clinical data was done, patients male were 43/62 (70%), female were 19/62 (29.6%) with mean age of 48.75 +/- 11.525, ranging from 35 to 84 years. 15/62 (25%) patients were attributed in group 1, 17/62 (28%) in group 2 and 30/62 (47%) in group 3. Otherwise considering presence or absence of metastatic disease at 18F-FDG PET/CT, 20/62 patients (32%) were included in group A and 42/62 (58%) in group B. There was a significant correlation of serum AFP level with metastatic disease in HCC (r=0.472, 0.0001).
This preliminary study suggests that serum AFP level, in patients affected by HCC has significant correlation with the presence of metastatic disease seen on 18F-FDG PET/CT. considering also that the use of 18F-FDG for the detection of recurrent HCC is controversial, because HCC displays varying FDG avidity. Studies about 18F-FDG PET/CT have shown that tracer uptake is higher in poorly differentiated HCC than in well-differentiated ones. This may be useful for detection of HCC and to differentiate between early and advance stage. On the basis of this findings treatment strategy can be planned.