Clinical analysis of low AFP level cases and their prognoses

In 1974 about 115,000 subjects from an urban population of Shanghai were screened by the reverse passive haemagglutination assay to detect serum AFP for early primary hepatocarcinoma. There were 282 cases with low AFP level, i.e., the AFP level was lower than that in primary liver cancer but higher than normal. Of this group of low AFP level, 270 cases were followed for 2 years: 9 developed liver cancer and 233 became AFP negative, while the titer of the other 38 remained unchanged. To investigate the significance of low AFP level, the status of liver function and the low AFP level was correlated. Fewer cases with abnormal liver function became AFP negative than those with normal liver function. The ratio of resultant AFP-negative individuals with normal and abnormal liver function were 3.5:1 at 1 year and 5:1 at 2 years. Those who failed to become AFP-negative were mainly those with abnormal liver functions. Furthermore there seemed to be a close relationship between persistent AFP abnormality and the liver diseases. Fewer cases with abnormal ZnTT (Zinc sulfate turbidity test) or with both abnormal GPT and ZnTT become AFP negative, and their incidence of liver cancer was high. In 95% of the cases with normal liver function, their AFP became negative and their cancer incidence was low during 2 years follow up. It is speculated that some of the patients with low AFP level were either in the precancerous stage or more susceptible to carcinogenesis. The patients with low AFP level were treated with traditional Chinese medicine and followed for 1 year. Fewer cases of cancer developed in the treated cases than in the untreated cases. It is important to find and treat these cases at an early stage in order to block or retard the development of liver cancer. A correlation of liver disease and liver cancer and the importance of routine checkup with periodic screening is stressed.