Alpha-fetoprotein should be included in the hepatocellular carcinoma surveillance guidelines of the American Association for the Study of Liver Diseases.

摘要

We read with interest the updated hepatocellular carcinoma (HCC) guidelines by the American Association for the Study of Liver Diseases. We were surprised by the omission of alpha-feto-protein (AFP) testing in the recommendations for HCC surveillance. We disagree with these recommendations. In making recommendations, the writers of practice guidelines should consider the quality of the evidence. The HCC guidelines ignore a significant amount of data about the use of AFP in the surveillance of patients at risk for HCC. The only available level 1 evidence for HCC surveillance comes from one randomized controlled trial of ultrasonography (US) combined with AFP testing every 6 months in a hepatitis B carrier population. The next best available evidence comes from a population-based cohort surveillance program involving hepatitis B carriers in Alaska that showed improved outcomes.