Serum AFP is used in combination with ultrasound every 6 months for HCC surveillance in c...
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | BMA-AFP-HCC-AASLD-SURVEILLANCE |
|---|---|
| Тип | Клінічна застосовність |
| Статус | переглянуто 2026-05-18 | потрібне рев’ю клінічної застосовності |
| Хвороби | DIS-HCC |
| Джерела | SRC-AASLD-HCC-2023 SRC-NCCN-HCC-2025 |
Дані про клінічну застосовність
| Біомаркер | BIO-AFP |
|---|---|
| Варіант | Alpha-fetoprotein — HCC surveillance in cirrhotics + chronic HBV |
| Хвороба | DIS-HCC |
| Рівень ESCAT | IIIA |
| Рекомендовані комбінації | Cirrhotic of any aetiology (Child-Pugh A/B7): US + AFP every 6 months, Chronic HBV high-risk (Asian/African ancestry men ≥40, women ≥50, family history, HBeAg+, high HBV DNA): US + AFP every 6 months even without cirrhosis, AFP >20 ng/mL or rising trajectory with negative US: multiphasic CT or MRI per LI-RADS |
| Протипоказана монотерапія | AFP alone (without imaging) is insufficient for HCC surveillance — AASLD does not endorse AFP-only screening |
| Підсумок доказів | Serum AFP is used in combination with ultrasound every 6 months for HCC surveillance in cirrhotic patients of any aetiology (Child-Pugh A/B7, candidates for treatment) and in non-cirrhotic chronic HBV with elevated HCC risk per AASLD HCC 2023. US-alone sensitivity is suboptimal (~63%); US + AFP raises sensitivity for early-stage HCC to ~70-80% with acceptable specificity (~85-90%). AFP threshold typically >20 ng/mL (some guidelines >7 ng/mL with risk-stratified cutoffs). Rising AFP trajectory is more informative than single value. AFP elevation also occurs in chronic hepatitis flares, regenerative nodules, germ-cell tumours, and gestation — interpret in context. Diagnostic workup of rising AFP: multiphasic CT or MRI per LI-RADS criteria. AFP-L3 fraction and DCP (PIVKA-II) are adjunct markers in some practices. ESCAT IIIA — AFP directs HCC diagnostic workup / surveillance cadence. |
Нотатки
STUB pending two-Co-Lead signoff. AASLD-aligned HCC surveillance Indication entities are partially authored — closest existing entities: ind_a1at_deficiency_hcc_lung_prevention_surveillance and the HCV/HBV prevention bundle. A general IND-CIRRHOSIS-HCC-SURVEILLANCE entity (aetiology-agnostic, gated on Child-Pugh class) is a future authoring task. AFP-L3 and DCP/PIVKA-II are adjunct markers not consistently guideline-endorsed for surveillance; render layer should not surface as primary surveillance. Special context: in post-SVR12 HCV cirrhotics, HCC risk persists at reduced level — AFP + US surveillance continues lifelong in those who reached F3/F4 fibrosis before cure.
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