Small HCCs identified by screening.

Background: Survival in HCC depends on diagnosis at early tumor stage, best achieved through surveillance radiology. There is also a need for complementary serum tests.

Methods: We evaluated baseline liver function parameters from a cohort of 231 HCC patients who were diagnosed by surveillance. They were ordered according to their tumor mass and trends in the data were analyzed.

Results: Trends in serum GGTP levels increased linearly with increases in small tumor mass, but the patterns for AFP levels were more complex and elevated only with larger tumor mass. ALKP levels were elevated in association with small tumors and further increased with increasing tumor mass. The relationships of serum AFP to GGTP, of albumin to bilirubin and of ALKP to bilirubin, helped identify tumor mass phenotypes. There was an especially important relationship between serum bilirubin and AFP, suggesting that HCC growth and liver factors were interdependent.

Conclusions: Small HCCs demonstrated several phenotypic sub-groups, with serum GGTP and ALKP increasing and albumin decreasing in many patients with increasing tumor mass.