Alpha-phetoprotein, for liver cancer screening

Primary liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer mortality worldwide, with an estimated 841,000 cases (9.3 cases per 100,000 person-years) and 782,000 deaths (8.5 deaths per 100,000 person-years) in 2018 . It is more common in men than in women.

Outcomes are poor with an estimated 5-year net survival of 19% (2009–2015) and an average 19 years of life lost per death in the USA .

Risk factor of liver cancer

  • Gender : liver cancer is much more common in men than in women

  • Ethnicity : Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by Hispanics/Latinos, American Indians/Alaska Natives, African Americans, and whites.

  • Chronic viral hepatitis : such as viral hepatitis B and C

  • Cirrhosis

  • Non-alcoholic fatty liver disease

  • Heavy alcohol use ( more than 14 drink/week for men and 7 drinks per week for women, one standard drink approximate 1 can of beer )

  • Tobacco use

  • Obesity

  • Type 2 diabetes

  • Long term exposure with Aflatoxins from fungus, that contaminates peanuts, wheat, soybeans, ground nuts, corn, and rice.

  • Exposure to Vinyl chloride and thorium dioxide (Thorotrast) raises the of the liver cancer. Vinyl chloride is a chemical used in making some kinds of plastics.

  • Anabolic steroids : Long-term anabolic steroid use can slightly increase the risk of Liver cancer.

AFP reference value

<8.4 ng/mL Reference values are for non-pregnant subjects only

Sensitivity and specificity

However, the sensitivity of AFP is only about 60% at a cut-off value of 20 ng/mL, and the specificity is low. Moreover, AFP levels remain normal in 15–30% of patients with advanced-stage disease and increase in some patients with chronic hepatitis, liver cirrhosis, and other liver diseases, leading to high negative and false-positive rates. Therefore, novel markers that complement the limitations of AFP are needed for screening and a more accurate diagnosis of HCC.


  1. Paramita Dasgupta, Global Trends in Incidence Rates of Primary Adult Liver Cancers: A Systematic Review and Meta-Analysis,Front Oncol. 2020

  2. "Liver cancer risk factor" American cancer society April 1, 2019

  3. " Alpha-Fetoprotein (AFP) Tumor Marker, Serum"

  4. Jian Hu " Diagnostic value of alpha-fetoprotein combined with neutrophil-to-lymphocyte ratio for hepatocellular carcinoma" BMC Gastroenterologyvolume 18, Article number: 186 (2018)

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