AFP-L3 in chronic liver diseases with persistent elevation of alpha-fetoprotein.
BACKGROUND
Alpha-fetoprotein (AFP) is an important marker for hepatocellular carcinoma (HCC). However, persistent elevation of AFP is found in patients with chronic liver diseases. The value of AFP-L3, which is more specific than AFP, was examined in such patients.


METHODS
We enrolled patients without image-detectable tumor, but with transient AFP value > 900 ng/mL (group A) or with persistent AFP value > 50 ng/mL for longer than 6 months (group B). Forty-one patients with HCC and AFP value > 50 ng/mL were included as the HCC control group (group C). AFP-L3 measurement was done by lectin-affinity electrophoresis coupled with antibody-affinity blotting. The study patients were followed with AFP, liver biochemistry and abdominal ultrasound at 3- to 6-month intervals. Additional studies were done when a tumor was suspected.


RESULTS
One of 17 patients in group A and 13 of 39 patients in group B developed HCC within 2 years. When the cutoff value of AFP-L3 ratio was 15%, both the sensitivity and specificity were 71% for prediction of HCC during the next 2 years in all patients. Ninety percent of tumors larger than 5 cm had AFP-L3 > 15%, compared with only 60% for tumors smaller than 2 cm. Three patients in group A had AFP-L3 ratio > 17.5%. One patient developed HCC 10 months later; the other 2 patients were associated with hepatic failure.


CONCLUSIONS
AFP-L3 provides a clue in HCC detection in patients with persistent elevation of AFP. However, AFP-L3 could be highly elevated in severe hepatitis.
Cheng
Hau-Tsai
HT
Liver Research Unit, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.
Chang
Ya-Hui
YH
Chen
Yang-Yuan
YY
Lee
Tzong-Hsien
TH
Tai
Dar-In
DI
Lin
Deng-Yn
DY
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood*; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood; D019698:Hepatitis C, Chronic / Q000097:blood; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011506:Proteins / Q000032:analysis*; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins
C097353:AFP protein, human; D011506:Proteins; D000509:alpha-Fetoproteins