Reference Change Value for -Fetoprotein and Its Ap- plication in Early Detection of Hepatocellular Carci- noma in Patients with Hepatic Disease, Jaume Trape ´, 1*

Hepatocellular carcinoma (HCC) is one of the most frequent types of cancer worldwide, with an incidence of 150 cases per 100 000 inhabitants per year in Asia and Africa and 5 cases per 100 000 per year in Europe, North America, and Australia (1 ). HCC can occur in healthy livers, but it is generally associated with hepatic disease. Cirrhosis is the most important risk factor for its development (2 ). Many studies have been dedicated to the early detection of HCC in patients with chronic liver disease (CLD), based on semiannual or annual measurement of serum -fetoprotein (AFP) and ultrasound study of the liver. The interpretation of AFP results usually involves comparison with a fixed cutoff ranging from 20 to 500 g/L, with sensitivities ranging from 33% to 64% (3– 5) . Another approach would be to assess changes in consecutive results from the same patient. To establish a criterion for dynamic assessment of a