Diagnostic Significance of Alpha Fetoprotein in Carcinomas of Liver and Biliary Tract - A Comparative Study from Western Region of Nepal

Objective: To assess the diagnostic significance of α-fetoprotein in carcinomas of liver and biliary tract with the overall goal of reducing morbidity and mortality in Pokhara valley. Materials and
Methods: It was a hospital based comparative study carried out in the Department of Biochemistry of Manipal Teaching Hospital, Pokhara, Nepal between 1st January 2009 and 31st December 2010. The variables collected were age, gender, serum alpha feto protein. Approval for the study was obtained from the institutional research ethical committee. Estimation of AFP was performed by ELISA reader for all cases. The standard procedure was followed as per manufacturer’s instructions for ELISA. All these laboratory parameters were analyzed using Human reagent kits and with the help of ELISA and semi autoanalyser (Humalyser 3500, Germany).
Results: Out of 1200 patients, there were 348(29%) cases of HCC. Out of that, 285 cases were found to be AFP positive with significant elevation. Furthermore, diagnosed cases were of cholangiocarcinomas (96, 8%) and secondary carcinomas of liver (216, 18%). In both of these clinical conditions, there was insignificant elevation of AFP. Another commonly diagnosed condition was cirrhosis (480, 40%) and in 90 cases, AFP values were moderately raised from the upper limit of normal reference range. The last diagnosed cases were of either Hepatitis A/E(60, 5%) and did not show any rise in levels of AFP.
Conclusion: Serological markers for hepatocellular carcinoma (HCC) are imperative for early identification, as well as scrutinizing of tumour aggressiveness, treatment responsiveness, reappearance and endurance. It is consequently justifiable to carry out the test for serum AFP to detect and differentiate at early stage of liver cell carcinomas.