Frequency and significance of serum α-fetoprotein elevation in severe hepatitis B surface antigen-negative chronic active hepatitis

Albert J. Czaja, Sandra J. Beaver, James R. Wood, George G. Klee, Vay L W Go

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To determine the frequency and significance of α-fetoprotein elevation in severe hepatitis B surface antigen-negative chronic active hepatitis, 558 serum samples obtained from 83 patients were tested by an immunoenzymometric assay. All patients received corticosteroids and sampling occurred at 6-12-mo intervals during 96 ± 6 mo of follow-up. Twenty-nine patients (35%) had an abnormal level. In 26 patients, the abnormality was at presentation. In 3 patients, the abnormality developed 11-127 mo later. Two of these patients had primary hepatocellular carcinoma. Serum aspartate aminotransferase levels were higher in patients with an α-fetoprotein elevation at presentation (p < 0.02). After therapy, the α-fetoprotein level normalized and patients entering remission had lower levels than at entry (p < 0.001). α-Fetoprotein levels, however, did not correlate closely with serum aspartate aminotransferase levels at entry nor did they distinguish patients with different patterns of histologic activity. Outcomes after therapy were similar in patients with and without α-fetoprotein elevation. Three patients (4%) developed primary hepatocellular carcinoma after 113 ± 26 mo but only 2 had elevated α-fetoprotein levels. We conclude that elevation of the α-fetoprotein level occurs commonly at presentation. The abnormality frequently resolves after corticosteroid therapy and it does not have prognostic significance. An elevation that occurs after treatment suggests primary hepatocellular carcinoma.

Original languageEnglish (US)
Pages (from-to)687-692
Number of pages6
Issue number4
StatePublished - 1987


ASJC Scopus subject areas

  • Gastroenterology

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