Evaluation of serum alpha fetoprotein-L3 as an accuracy novel biomarker for the early diagnosis of hepatocellular carcinoma in Egyptian patients

Abstract

Background Most Hepatocellular Carcinomas (HCCs) are diagnosed at an advanced stage. However, HCC early diagnosis is complicated by the coexistence of inflammation and cirrhosis. The unsatisfactory sensitivity and specificity of Alpha-fetoprotien (AFP) for screening of early-stage HCC paved the way for new novel biomarkers to complement AFP such as AFP-L3. The aim of this study was the Evaluation of alpha fetoprotein-L3 (AFP-L3) as earlier marker in diagnosis of hepatocellular carcinoma in Egyptian patients. This study was conducted on 80 patients categorized into 2 groups; group 2 (40 patients with chronic active hepatitis) and group 3 (40 patients with HCC). HCC diagnosis was done by clinical, triphasic CT and positive US for focal lesion, in addition to 20 healthy individuals as controls (group 1). Results The median range of AFP and AFP-L3 were highly statistically significant difference between HCC group and other groups [ p < 0.001]. In this study ALT, AST, Total & direct bilirubin and albumin results showed highly significant differences between HCC group and other groups. Serum AFP-L3 shows sensitivity 100%, specificity 100%, positive predictive value 100% and negative predictive value 100% with AUC = 1 in HCC cases. Conclusion Serum AFP-L3 may serve as a diagnostic biomarker for the detection of early stage of HCC and show higher sensitivity than AFP.

Update on the applications and limitations of alpha-fetoprotein for hepatocellular carcinoma

“…In a large multicenter prospective study of hepatitis C virus related HCC, the specificity of AFP-L3 was observed to be 92% but its sensitivity was fairly low at 37%, irrespective of the tumor stage[ 36 ]. On the contrary, a number of recent studies reported a much higher sensitivity of AFP-L3 for diagnosing HCC[ 37 - 39 ]. Ibrahim et al [ 39 ] evaluated the diagnostic efficacy of AFP-L3 among 20 healthy individuals, 40 patients of chronic active hepatitis and 40 HCC patients with underlying chronic hepatitis B (CHB) or C. Among the HCC patients, 30 (75%) had tumor size > 5 cm.…”

“…On the contrary, a number of recent studies reported a much higher sensitivity of AFP-L3 for diagnosing HCC[ 37 - 39 ]. Ibrahim et al [ 39 ] evaluated the diagnostic efficacy of AFP-L3 among 20 healthy individuals, 40 patients of chronic active hepatitis and 40 HCC patients with underlying chronic hepatitis B (CHB) or C. Among the HCC patients, 30 (75%) had tumor size > 5 cm. At a cut-off point of > 12.3 ng/mL, AFP-L3 was 100% accurate in diagnosing the HCC[ 39 ].…”

“…Ibrahim et al [ 39 ] evaluated the diagnostic efficacy of AFP-L3 among 20 healthy individuals, 40 patients of chronic active hepatitis and 40 HCC patients with underlying chronic hepatitis B (CHB) or C. Among the HCC patients, 30 (75%) had tumor size > 5 cm. At a cut-off point of > 12.3 ng/mL, AFP-L3 was 100% accurate in diagnosing the HCC[ 39 ]. In a study by Ibrahim et al [ 39 ], 20 healthy individuals, 20 chronic liver disease patients and 40 patients HCV-induced HCC were included in the analysis.…”

“…At a cut-off point of > 12.3 ng/mL, AFP-L3 was 100% accurate in diagnosing the HCC[ 39 ]. In a study by Ibrahim et al [ 39 ], 20 healthy individuals, 20 chronic liver disease patients and 40 patients HCV-induced HCC were included in the analysis. A large proportion (65%) of the HCC patients had advanced stage of HCC.…”

The Value of MRI Combined with AFP, AFP-L3, GP73, and DCP in the Diagnosis of Early Primary Liver Cancer

“…Kong et al reported that the combined detection of enhanced CT and contrast-enhanced ultrasound with tumor markers such as AFP is helpful for the early diagnosis of PHC (35237392). Alpha-fetoprotein-L3 (AFP-L3), a subtype of AFP, has been reported to have high specificity for early PHC diagnosis [ 12 , 13 ]. In recent years, Golgi protein 73 (GP73) was found to be significantly elevated in the serum of PHC patients, and it was considered a biomarker for diagnosing early PHC [ 14 , 15 ](33343966).…”