Clinical Evaluation of Lens Culinaris Agglutinin-Reactive α-Fetoprotein and Des-γ-Carboxy Prothrombin in Histologically Proven Hepatocellular Carcinoma in the United States

Abstract

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.

Prognostic Value of Serum AFP, AFP-L3, and GP73 in Monitoring Short-term Treatment Response and Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

“…Many studies (Tangkijvanich et al, 2000;Fujioka et al, 2001;Carr et al, 2007;Yamamoto et al, 2010;Saito et al, 2012) revealed that AFP levels > 400 ng/mL were indicative of larger tumor size, greater tumor numbers, a later clinical phase, bile duct invasion, vascular invasion, and a shorter median survival time. Elevated AFP-L3 levels were associated with larger tumor size, a later clinical stage, vascular invasion, poor tumor differentiation, and distant metastasis (Oka et al, 2001;Yoshida et al, 2002;Carr et al, 2007;Saito et al, 2012). Other research studies (Riener et al, 2009;Hu et al, 2010) observed that GP-73 levels were significantly higher in patients with hepatitis C-derived HCC and a high tumor grade.…”

Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

“…There are reports that a high DCP level correlates with invasiveness and the metastasizing property of carcinoma [2][3][4][5][6][7][8] . Shirabe et al [8] reported that the preoperative DCP level, tumor diameter, and histologic differentiation correlated with the presence or absence of microscopic vascular invasion in a study on 218 patients who had undergone hepatic resection.…”

“…An assay that employs higher DCP diagnostic sensitivity has been introduced [25,26] , but the diagnostic sensitivity for small hepatocellular carcinoma still remains at about 50% [27][28][29][30] . Thus, most reports on biological properties of DCP positive hepatic carcinoma are based on more advanced diseases [7] . Many reports state high DCP levels to be of poor prognostic value.…”

“…It is believed that the elevation of the serum DCP level correlates with the presence of vascular invasion or intrahepatic metastases [2][3][4][5][6][7][8] . Furthermore, DCP has been reported to be an independent prognostic factor for recurrence and survival after hepatic resection [4,[9][10][11][12][13] , liver transplantation [6,14] , ablation treatment [15][16][17] , and transarterial chemoembolization (TAE) treatment [18] .…”

Application of HBx-induced anti-URGs as early warning biomarker of cirrhosis and HCC

“…Presently, a-fetoprotein (AFP) is the generally accepted serological marker for HCC diagnosis, but sensitivity of the AFP assay is only 47% (The specificity is 96%) and cut-off value useful in tumor diagnosis is high (50 mg/L) [31]. Combined determination of AFP with AFP-L3 (Lens culinaris agglutinin reactive AFP), des-γ-carboxy prothrombin (DPC) could improve the sensitivity to 85% while the specificity would decrease to 59% [32,33].…”