Quick Summary
The incidence of AFP-negative HCC is increasing worldwide, particularly HCCs of nonviral etiology, such as MASLD/MASH. A high percentage of patients with MASLD/MASH-related HCC are positive for PIVKA-II, even those who are negative for AFP[1]. Higher levels of AFP-L3 have also been reported in cases of MASLD/MASH-related HCC [2]. Thus, the role of PIVKA-II and AFP-L3 measurements in HCC surveillance and diagnosis of AFP-negative HCCs has become more important.
This article by Prof Masatoshi Kudo details the importance of testing all 3 biomarkers, AFP, AFP-L3, and PIVKA-II, in HCC surveillance and management. He also discusses new algorithms, such as GALAD and GAAD, which incorporate these biomarkers have been useful in countries where access to imaging is limited.
References:
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- Nouso K, Furubayashi Y, Kariyama K, Wakuta A, Miyake N, Inoue K, Nagai Y, Murakami S, Adachi T, Oyama A, Wada N, Takeuchi Y, Sakata M, Yasunaka T, Onishi H, Shiraha H, Takaki A, Shiota S, Yasuda S, Toyoda H, Kawanaka M, Kumada T, Okada H. Abnormal fucosylation of alpha-fetoprotein in patients with nonalcoholic steatohepatitis. Hepatol Res. 2021 May;51(5):548-553. doi: 10.1111/hepr.13626. Epub 2021 Mar 19. PMID: 33596344.
