A clinical study of lectin-reactive alpha-fetoprotein as an early indicator of hepatocellular carcinoma in the follow-up of cirrhotic patients

Abstract

Levels of two types of lectin-reactive alpha-fetoprotein (AFP), designated AFP-L3 and AFP-P4+P5, were analyzed with Lens culinaris agglutinin A and AFP-P4+P5 with erythroagglutinating phytohemagglutinin, respectively, in an attempt to determine the utility and significance of these macromolecules as early indicators of hepatocellular carcinoma during the periodic follow-up of cirrhotic patients. The subjects were 51 of 190 consecutive cirrhotic patients in whom hepatocellular carcinoma developed during a 6-year follow-up period and 21 cirrhotic patients without hepatocellular carcinoma. Serum AFP levels were of limited value to diagnose and predict hepatocellular carcinoma. The relative levels of AFP-L3 and AFP-P4+P5 in patients with hepatocellular carcinoma at the time of tumor detection were significantly higher than those in patients with cirrhosis. The sensitivity was 61%, and the specificity was 90%. Fourteen patients (48%) of 29 patients with small hepatocellular carcinomas less than 2 cm in diameter showed elevated percentage of lectin-reactive AFP. Retrospective examination of 21 patients who were positive for lectin-reactive AFP at diagnosis of hepatocellular carcinoma showed that 41% of them had already expressed lectin-reactive AFP 12 months before the direct detection of hepatocellular carcinoma by diagnostic imaging. These results lead us to conclude that the level of lectin-reactive AFP is a suitable predictive marker for the early recognition of hepatocellular carcinoma in the follow-up of patients with cirrhosis, and that measurements of the level of lectin-reactive AFP should be added to the screening methods that are now in use.

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

“…Finally, 17 articles were included in our study (Fig. 1, Table 1) [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84]. Eleven studies included data on more than one tumor marker [70, 71, 73-77, 79-81, 83], and 4 of them provided sensitivity and specificity of a combination of two tumor markers [70,74,77,79].…”

The Human Cervical Cancer Oncogene Protein Is a Biomarker for Human Hepatocellular Carcinoma

“…AFP-L3 has been reported to be a useful marker in the early diagnosis of HCC. Its diagnostic accuracy varied from 17% to 42% in small HCC of Ͻ2 cm (22)(23)(24)(25). Previous work has suggested that simultaneous measurement of serum des-␥-carboxy prothrombin and AFP-L3 in patients with small HCC increased the sensitivity to 54.1%; specificity and accuracy increased to 97.8% and 84.1%, respectively (26).…”

Semi-quantitative Measurement of a Specific Glycoform Using a DNA-tagged Antibody and Lectin Affinity Chromatography for Glyco-biomarker Development *

“…AFP has been the core biomarker for HCC, but because of the low sensitivity of the biomarker guidelines of the American Association for the Study of Liver Diseases do not include the usage of the AFP test for HCC surveillance for high-risk patients (27). AFP-L 3 %, an LCA-retained fuco-fraction of AFP, has been suggested as a means to complement the unsatisfactory clinical outcomes that are particularly observed for HCC patients with low AFP serum level (28,29). However, studies failed to support the increased validity of AFP-L 3 % over the use of AFP alone.…”

“…This indicates a limited utility of AFP because of low specificity for prediction or diagnosis of HCC. Because it has been reported that the ratio of AFP-L 3 to total AFP could be highly specific for HCC, AFP-L 3 has been a preferred HCC biomarker to AFP levels and extensive investigations culminated in FDA-approval of an AFP-L 3 lab test to determine the risk of developing liver cancer in patients with chronic liver disease (11). Besides AFP-L 3 , several glycan indicators of a relationship with cancer states including CA15-3 and CA19-9, have been reported in terms of relationship with cancer states (12,13).…”