There is no established clinical role for the lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3%) and des-gamma-carboxy prothrombin (DCP) in the management of the U.S. hepatocellular carcinoma (HCC) patient population. In order to clarify the clinical usefulness and characteristics of AFP-L3% and DCP, a prospective study was performed on United States patients having histologically proven hepatocellular carcinoma. Ninety-nine histologically proven HCC patients, who were diagnosed with unresectable cancer between July 1999 and March 2001 at the Liver Cancer Center of the University of Pittsburgh Medical Center, were included for analysis. The sensitivity of AFP-L3%, DCP, and AFP was 61.6%, 72.7%, and 67.7%, respectively. The highest sensitivity, 85.9%, was obtained in the combination of three markers. Statistically significant differences were observed for portal vein invasion in AFP-L3% and AFP levels (P = 0.0059 and P = 0.0360, respectively). DCP was significantly associated with metastasis (P = 0.0368). There were significant associations between AFP-L3% and AFP results and patient survival (P = 0.0150 and P = 0.0020, respectively). AFP-L3%, platelet count,and albumin showed a significant difference with respect to outcomes on Cox's proportional hazard model (P = 0.0059, P = 0.0073, and P = 0.0265, respectively). The combination of AFP-L3%, DCP, and AFP was determined to be superior for detection of HCC compared with each marker alone or to other combinations. AFP-L3% was significantly related to portal vein invasion and patient outcomes and appears to be a useful prognostic marker for HCC.
The Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) has been used as a diagnostic and prognostic marker of hepatocellular carcinoma (HCC). The analytical sensitivity of a conventional method for AFP-L3% % is not sufficient in patients with a low AFP level. This study was performed to determine the clinical utility of a newly developed highly sensitive AFP-L3% % (hs-AFP-L3% %) assay in patients with an AFP level <20 ng ⁄ mL. In the cohort study, serum samples obtained from 270 patients with newly diagnosed HCC before treatment and 396 patients with chronic liver disease at Ogaki Municipal Hospital, in both of which the AFP level was <20 ng ⁄ mL, were measured for conventional AFP-L3% % (c-AFP-L3% %), hs-AFP-L3% % and des-gamma-carboxy prothrombin (DCP). Diagnostic sensitivity and specificity of hs-AFP-L3% % at a cut-off level of 5% % were 41.5% % and 85.1% %, respectively, significantly increasing the sensitivity from 7.0% % for c-AFP-L3% %. Multivariate analysis identified hs-AFP-L3% % as an independent factor associated with reduced long-term survival. The survival rate of patients with high hs-AFP-L3% % ( ‡5% %) before treatment was significantly poorer than that of patients with low hs-AFP-L3% % (<5% %) (P < 0.001). In patients with AFP <20 ng ⁄ mL, measurements of AFP-L3% % by the highly sensitive method before treatment were more useful for diagnosis and prognosis of HCC than by the conventional method. (Cancer Sci 2011; 102: 1025-1031 H epatocellular carcinoma (HCC) is the sixth most common cancer in the world, and the third most common cause of cancer-related death.(1) A diagnosis of HCC is typically marked with a poor prognosis, largely because early HCC is difficult to diagnose. Three tumor markers, alpha-fetoprotein (AFP), (2)(3)(4)(5) Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) (6)(7)(8) and des-gamma-carboxy prothrombin (DCP), (9)(10)(11) are currently available as serological markers of HCC for surveillance, diagnosis and patient outcome prediction. Alpha-fetoprotein has been widely used as an in vitro diagnostic, and different cut-off values have been proposed by previous studies. (12)(13)(14) However, total AFP is not always specific for HCC, especially when HCC is in the early stages. In contrast, a fucosylated fraction of AFP (AFP-L3) is highly specific for HCC. A combination assay of AFP-L3% and DCP results in an improvement in diagnostic sensitivity compared with AFP-L3% or DCP alone.(15) Furthermore, higher levels of AFP-L3% prior to treatment are also associated with poorer prognosis. (8,16,17).The percentage of AFP-L3 is determined by AFP-L3 concentration divided by the total AFP concentration in serum. Therefore, the analytical sensitivity for AFP-L3% can be affected inversely by the total AFP concentration. In addition, the clinical usefulness of AFP-L3% has been hampered by insufficient analytical sensitivity of the conventional assay system in patients with a low AFP level, which is a liquid-phase binding assay on an auto-analyzer ...
While certain cases showed a discrepancy in fucosylated haptoglobin concentrations between the lectin-antibody ELISA and conventional lectin blotting, this novel type of lectin-antibody ELISA might be useful for a tumor marker for PC.
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