Evaluation of HCV-associated Hepatocellular Carcinoma Based on Alpha-fetoprotein Levels Elsayed S. Abd elbaser1, Marwa A. Shabana2, Abeer Hussein Abdelkader1, Samir Abdel-Azim Afifi³ Tropical Medicine 1, Clinical Pathology2 , Internal medicine³ Abstract Background and study aim: Alpha-fetoprotein (AFP) cannot be relied on alone for diagnosis of hepatocellular carcinoma (HCC). However, it may have a prognostic value and can be used for monitoring response to different modalities of treatment for HCC. This study aimed to differentiate the clinical and pathological features of HCCs according to AFP levels. Subjects and Methods: This retrospective study included 60 patients with HCC secondary to chronic hepatitis C (HCV). They were divided based on serum AFP into two groups; group I; included 30 patients with AFP lower than 302.5ng/ml. and group II; included 30 patients with AFP higher than 302.5ng/ml. clinical, laboratory and pathological differences between both groups were compared. Results: Regarding the pathological features, patients with higher AFP secreting tumors have larger tumor size compared to lower AFP secreting tumors; (5.8 cm Vs. 4.5 cm, P value; 0.001). Number of lesions and tumor location were similar between the two groups. Conclusion: HCC-secreting high levels of AFP are larger and aggressive tumors when compared to low secreting AFP-HCC. Key words: alpha-fetoprotein, hepatocellular carcinoma, chronic hepatitis C.