How would you approach a patient with newly diagnosed hepatocellular carcinoma with very high AFP (>100,000) but no clear radiographic evidence of metastatic disease?

This is a challenging situation. Oftentimes, these patients have significant vascular involvement of their tumor. AFP has been shown to correlate with survival and those with markedly elevated (>100,000) have a very poor prognosis (REACH, REACH2, Zhu et al., PMID 33531690).

If a patient has known HC...

Elevated AFP levels are indicative of high tumor aggressivity, and microvascular invasion (MVI). (Fan et al., PMID 23321029) Post-treatment AFP response may serve as a non-invasive tool to monitor treatment efficacy and can predict the survival of HCC patients who were treated with liver transplant,...