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The serum concentration and degree of fucosylation (fucosylation index) of alpha-fetoprotein (AFP) were determined in serum samples from 258 patients with hepatocellular carcinoma (HCC) and 114 patients with benign liver diseases. When the serum AFP concentration was below 1000 ng/ml, it could not be used as a measure to distinguish between HCC and benign liver diseases. However, the fucosyla-tion index of AFP proved useful for such a purpose. The sensitivity of the analysis using the fucosylation index in total patients with HCC was 69%; the specificity was 96% in benign liver diseases, and the accuracy of this test was 77%. When HCC patients who were grouped according to tumor size (5 cm, 3 cm, and 2 cm in diameter) were analyzed, they all had a fucosylation index significantly higher than that in benign liver disease patients. The mean fucosylation index in 28 patients with a serum AFP concentration below 1000 ng/ml and a tumor diameter less than 3 cm was 26 k 30%. Corresponding values for 16 patients with an AFP concentration below 400 ng/ml and a tumor size less than 3 cm and for 8 patients with a concentration below 400 ng/ml and a tumor size less than 2 cm were 32 +-31% and 27 ? 27%, respectively. These values were higher, with statistical significance, than those in patients with benign liver diseases. These data indicate that the measurement of the fucosylation index of AFP is useful for the early diagnosis of HCC. Cancer 61:769-774, 1988. LPHA-FETOPROTEIN (AFP), one of the best known A carcinofetal proteins, appears to be useful for the diagnosis of hepatocellular carcinoma (HCC) during the follow-up process of patients with chronic liver dis-ease~.'-~ However, the serum concentration of AFP also increases in benign liver diseases such as hepatic cirrho-sis and fulminant Therefore, it is important to develop a method that distinguishes between HCC and nonneoplastic liver diseases. We have recently reported that the measurement of the lentil lectin reactive species of AFP is useful for such a and that fucosylation of the sugar chain is the molecular basis for this variation of AFP.9 We also observed five HCC patients who showed a dramatic increase in fucosylation of AFP in association with neo-plastic transformation of hepatocytes after a long history of hepatic cirrhosis." This suggests that the degree of fucosylation (fucosylation index) is a good measure for HCC. In this article we report the detailed analyses of the usefulness of measuring the fucosylation index in the early diagnosis of HCC. Patients and Methods Patients Three hundred and seventy-two serum samples from 258 patients with HCC and 114 patients with benign liver diseases (1 3 patients with acute viral hepatitis, 43 with chronic hepatitis, and 58 with hepatic cirrhosis) were used for this study. The diagnosis, the presence, and the absence of HCC were determined by ultrasonog-raphy, scintigraphy, computed tomography, and selective celiac artenography. Tumor diameter was estimated by arteriography. AFP Determinations The serum concentrat...

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Electron microscopic observations in 30 cases of HBsAg positive liver disease and 12 asymptomatic carriers of HBsAg suggested the following mechanism of intracellular development of Dane particles: core particles migrated from the nucleus into the cytoplasm through the nuclear pores. Intracytoplasmic core particles protruded into the cisternae of endoplasmic reticulum by budding the outer coat of Dane particles being derived from the membrane of endoplasmic reticulum. Release of Dane particles into the blood stream by reversed pinocytosis was suggested by the finding of submembranous localization of endoplasmic reticulum containing these particles. No budding from the cell surface of the hepatocytes was encountered. Dane particles in the hepatocytes were detected in 14 of 15 cases positive for serum HBeAg while no particles were seen in 27 HBeAg negative cases, thus suggesting that serum HBeAg reflected ongoing replication of hepatitis B virus in the hepatocytes.