Synchronous and Metachronous Colorectal Cancers: Distinct Disease Entities or Different Disease Courses?

Background/Aims: The role of serum alpha-fetoprotein (APP) determination in hepato cellular carcinoma (HCC) surveillance is controversial. Methods: We reviewed a total of 132 patients (mean age 57.8 +/- 9.6, males = 101 (76%); HBsAg positive = 109 (82.6%); cirrhosis = 94 (71.2%)) who were diagnosed with HCC during regular surveillance test with ultrasound (US) and AFP. Results: The primary mode of tumor detection was US only in 51.5%, US and AFP in 22.0%, APP only in 19.7%, and incidental in 6.8% of patients. US detected 68.5% of tumor diagnosed at early stage, which was significantly lower than tumor beyond-early stage (85.0%, p = 0.048). AFP doubling (an increase in AFP level more than double from a prior surveillance) was more frequently observed in HBV-related FCC (47.7%) than HCV-related FCC (11.8%, p = 0.009). The AFP increased sensitivity by 19.7% for all patient; 28.0% for HBV-related early stage FCC patients. Conclusions: This result suggest that serum APP measurements may have a significant role in increasing sensitivity in FCC surveillance, especially for detecting early stage HBV-related HCC.