title: Alpha-fetoprotein as a tumor marker in hepatocellular carcinoma: investigations in south Indian subjects with hepatotropic virus and aflatoxin etiologies.
abstract: OBJECTIVE
  The prevalence of hepatitis B virus (HBV) is reportedly the main cause of hepatocellular carcinoma (HCC) in India, where hepatitis C virus (HCV)-associated HCC is believed to be relatively less prevalent. We verified the usefulness of alpha-fetoprotein (AFP) as a tumor marker and analyzed the influence of viral etiology on AFP levels in HCC.
  
  
  METHODS
  Of a total of 1012 cases with liver disease, 202 were investigated for the presence of AFP (142 HCC cases, 30 cirrhosis cases, and 30 chronic liver disease (CLD) cases). In addition, serum samples from 30 healthy patients, 30 hepatitis B surface antigen (HBsAg) carriers, and 30 acute viral hepatitis cases were included as controls. AFP was quantitatively determined using a commercial ELISA (Quorum Diagnostics, Canada). Out of the 142 HCC cases screened for AFP, aflatoxin B1 (AFB1) detection was carried out in 38 HCC cases using an in-house immunoperoxidase test.
  
  
  RESULTS
  In HBV and HCV co-infected HCC cases, the AFP positivity was 85.7%. In HBV alone-associated HCC, the positivity was 62.9%, and 54.5% of AFB1 positive HCC cases showed AFP positivity. In HBV and HCV negative HCC cases, the positivity was 20.5%, and in HCV-associated HCC it was 17.6%. The HBV/HCV co-infected group and HBV alone positive HCC cases had significantly elevated levels of AFP. When AFP positivity was analyzed based on the marker profile of HBV, 89.7% of AFP positive cases were HBV-DNA positive.
  
  
  CONCLUSIONS
  The overall positivity pattern of AFP in HCC does indicate that higher levels of AFP are observed with hepatitis virus positivity, especially with HBV. Further studies must be carried out to correlate the serum levels of AFP with the size, number, and degree of differentiation of HCC nodules.
authors.affiliation: Infectious Diseases Laboratory, YRG Centre for AIDS Research & Education, VHS Hospital Campus, Taramani, Chennai 600 113, India. murugavel@yrgcare.org
authors.forename: Kailapuri G
authors.initials: KG
authors.lastname: Murugavel
authors.forename: S
authors.initials: S
authors.lastname: Mathews
authors.forename: V
authors.initials: V
authors.lastname: Jayanthi
authors.forename: Esaki Muthu
authors.initials: EM
authors.lastname: Shankar
authors.forename: R
authors.initials: R
authors.lastname: Hari
authors.forename: R
authors.initials: R
authors.lastname: Surendran
authors.forename: Appasamy
authors.initials: A
authors.lastname: Vengatesan
authors.forename: K
authors.initials: K
authors.lastname: Raghuram
authors.forename: P
authors.initials: P
authors.lastname: Rajasambandam
authors.forename: A
authors.initials: A
authors.lastname: Murali
authors.forename: Usha
authors.initials: U
authors.lastname: Srinivas
authors.forename: K R
authors.initials: KR
authors.lastname: Palaniswamy
authors.forename: T
authors.initials: T
authors.lastname: Pugazhendhi
authors.forename: Sadras Panchatcharam
authors.initials: SP
authors.lastname: Thyagarajan
mesh_terms: D000348:Aflatoxins / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000378:metabolism / Q000821:virology; D002353:Carrier State / Q000378:metabolism; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000150:complications / Q000378:metabolism / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006526:Hepatitis C / Q000150:complications / Q000378:metabolism / Q000821:virology; D006801:Humans; D007194:India; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism / Q000821:virology; D008113:Liver Neoplasms / Q000209:etiology / Q000378:metabolism / Q000821:virology; D008297:Male; D008875:Middle Aged; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000348:Aflatoxins; D014408:Biomarkers, Tumor; D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins