Alpha-fetoprotein and Carcinoembryonic Antigen in Patients with Primary Liver Carcinoma, Metastatic Liver Disease, and Alcoholic Liver Disease

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Abstract
Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), alkaline phosphatase (ALP) and γ-glutamyltranspeptidase (GT) were determined in three groups of patients: 21 with primary liver carcinoma (PLC), 106 with metastatic liver disease, and 110 with various degrees of alcoholic liver diseases. AFP was elevated in 12 out of 14 with hepatocellular carcinoma but in none of 7 with cholangiocarcinoma. CEA was elevated in 8 of 14 with hepatocellular carcinoma and in 5 of 7 with cholangiocarcinoma. In metastatic liver disease, 83% had elevated CEA ≥ 5.0 μg/l, 50% having CEA levels > 20μg/l. AFP was moderately elevated in 26% of the patients, the values being < 100 μg/l in all but one. In patients with alcoholic liver disease, 31% had elevated CEA levels ≥5.0 μg/l; one of these had an extremely high value of 245 μg/l. AFP was moderately elevated to < 100 μg/l in only 9%. CEA is a sensitive indicator of metastases: a value above 20 μg/l is almost always associated with malignancy. However, the presence of alcoholic liver diseases must be considered in evaluating patients with increased CEA levels. AFP and CEA seemed to be of value in differentiation between primary and secondary liver carcinoma. ALP and GT are also relatively sensitive indicators of malignant liver disease, but they are more unspecific than AFP and CEA.