title: Clinicopathologic features of patients with primary malignant hepatic tumors seropositive for alpha-fetoprotein-L3 alone in comparison with other patients seropositive for alpha-fetoprotein-L3.
abstract: BACKGROUND
  Patients with hepatocellular carcinoma (HCC) seropositive for lectin-reactive alpha-fetoprotein (AFP-L3) have a poor prognosis. However, there have been no studies of the clinicopathologic features of patients seronegative for both AFP and des-gamma-carboxy prothrombin (DCP), and seropositive for AFP-L3 alone in comparison with other patients seropositive for AFP-L3.
  
  
  METHODS
  Patients with primary malignant hepatic tumors seropositive for AFP-L3 who underwent hepatectomy (n = 84) were divided into four groups, and their clinicopathologic features were compared: (i) group A, seronegative for AFP <100 ng/mL and DCP <40 mAU/mL; (ii) group B, seropositive for AFP > or =100 ng/mL and seronegative for DCP; (iii) group C, seronegative for AFP and seropositive for DCP > or =40 mAU/mL; and (iv) group D, seropositive for AFP and DCP.
  
  
  RESULTS
  Among the 14 group A patients seropositive for AFP-L3 alone with low AFP concentrations, three had intrahepatic cholangiocarcinoma (ICC), one had a cholangiolocellular carcinoma, one had combined HCC and ICC, and one had undifferentiated hepatic sarcoma. Group A had a higher incidence of non-HCC tumors (P < 0.001) and tumors derived from cholangiocytes (P < 0.001) than the other three groups. They also had a high frequency of poorly differentiated tumors and sarcomatous changes, and showed a poor prognosis.
  
  
  CONCLUSIONS
  Patients with primary malignant hepatic tumors seropositive for AFP-L3 alone with low AFP concentrations have unique clinicopathologic features. Thus, we should be aware of these patients and should measure AFP-L3 levels, at least once, even in those seronegative for both AFP and DCP.
authors.affiliation: Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okuda
authors.forename: Akiko
authors.initials: A
authors.lastname: Saito
authors.forename: Keiko
authors.initials: K
authors.lastname: Shiratori
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakano
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012509:Sarcoma / Q000097:blood / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin