Journal of the Chinese Medical Association
Volume 70, Issue 8 , Pages 310-317, August 2007

AFP-L3 in Chronic Liver Diseases with Persistent Elevation of Alpha-fetoprotein

  • Hau-Tsai Cheng

      Affiliations

    • Liver Research Unit, Chang Gung Memorial Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Ya-Hui Chang

      Affiliations

    • Liver Research Unit, Chang Gung Memorial Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Yang-Yuan Chen

      Affiliations

    • Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Tzong-Hsien Lee

      Affiliations

    • Liver Research Unit, Chang Gung Memorial Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Dar-In Tai

      Affiliations

    • Liver Research Unit, Chang Gung Memorial Hospital, Changhua, Taiwan, R.O.C.
    • Chang Gung University College of Medicine, Taoyuan, and Changhua, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Dar-In Tai, Liver Research Unit, Chang Gung Memorial Hospital, 199, Tun-Hwa North Road, Taipei 105, Taiwan, R.O.C.
    • ,
  • Deng-Yn Lin

      Affiliations

    • Liver Research Unit, Chang Gung Memorial Hospital, Changhua, Taiwan, R.O.C.
    • Chang Gung University College of Medicine, Taoyuan, and Changhua, Taiwan, R.O.C.

Received 24 January 2007; accepted 9 July 2007.

Article Outline

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.

Conclusion

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.

Key words:  α-fetoprotein , chronic hepatitis , hepatocellular carcinoma , lectin-reactive α-fetoprotein

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PII: S1726-4901(08)70011-X

doi:10.1016/S1726-4901(08)70011-X

Journal of the Chinese Medical Association
Volume 70, Issue 8 , Pages 310-317, August 2007

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