Association of alpha-fetoprotein levels with tumour size and aetiological factors in hepatocellular carcinoma: A cross-sectional analysis

Background: Alpha-fetoprotein (AFP) remains the most widely used biomarker in hepatocellular carcinoma (HCC) for diagnosis, disease monitoring, and prognostic assessment. However, AFP expression varies across tumour burden and underlying disease aetiology, which may influence its clinical utility.

Aim: To evaluate the association of serum AFP levels with tumour size and aetiological factors in patients with hepatocellular carcinoma.

Methods: This cross-sectional study was conducted at Dow University of Health Sciences / Civil Hospital Karachi between October 2017 and April 2018. A total of 94 patients with newly diagnosed hepatocellular carcinoma were included using non-probability consecutive sampling. Demographic characteristics, tumour size, and aetiological factors were recorded. Serum AFP levels were measured and stratified according to age, gender, tumour size, and underlying aetiology. Statistical analysis was performed using independent t-tests and ANOVA, with p≤0.05 considered significant.

Results: The mean age of the patients was 49.33 ± 15.86 years, with a nearly equal gender distribution (47.9% male, 52.1% female). The mean AFP level was 1356.06 ± 898.36 ng/mL. Hepatitis B was the most common underlying cause (36.2%), followed by hepatitis C (27.7%). AFP levels were significantly higher in patients younger than 45 years compared to those older than 45 years (1621.78 ± 948.66 vs 1112.04 ± 740.22 ng/mL; p=0.005).

Tumour size demonstrated a significant association with AFP levels (p=0.001), with larger tumours showing higher AFP expression. Alcoholism (p<0.001) and obesity (p<0.001) were also associated with significantly elevated AFP levels.

Conclusion: Serum AFP levels in hepatocellular carcinoma are significantly influenced by tumour size, age, and certain underlying aetiologies. These findings support the role of AFP as a marker of tumour burden and disease characterisation, particularly in resource-limited settings where access to advanced imaging may be restricted.