Clinical evaluation of serum alpha‐fetoprotein–IgM immune complexes on the diagnosis of primary hepatocellular carcinoma

Abstract

We evaluated clinical significance of serum alpha-fetoprotein (AFP)-IgM immune complexes, in comparison with free AFP, on the diagnosis of primary hepatocellular carcinoma (HCC). Serum levels of AFP-IgM immune complexes and free AFP were determined by the ELISA method and electrochemiluminescence, respectively, in 103 healthy controls, 74 patients suffering from primary HCC, 27 patients suffering from liver cirrhosis, and 63 patients suffering from chronic hepatitis. The best cut-off value of AFP-IgM and free AFP for diagnosis of primary HCC were 300 AU/mL and 10 microg/L respectively, according to the area under the curve (AUC) in this study. The sensitivity of AFP-IgM and free AFP were 64.9 and 79.7%, and the specificity were 75.6 and 80.3%, respectively, when all cases of primary HCC were analyzed, and the AUC of free AFP was larger than that of AFP-IgM (0.85 vs. 0.72, Z=3.21). However, in case of primary HCC at early stages (stages I and II) were analyzed, the AUC of AFP-IgM was larger than that of free AFP (0.91 vs. 0.82, Z=1.73), which demonstrated that the sensitivity of AFP-IgM and free AFP were 94.4 and 72.2%, and the specificity were 81.9 and 79.9%, respectively. When both AFP-IgM and free AFP were positive, the specificity of diagnosis of primary HCC was 89.1%, and the efficacy was 79.0%. It is concluded that either sensitivity or specificity of serum level of AFP-IgM immune complexes was higher than that of free AFP in the diagnosis of primary HCC at early stages. As there was false positive AFP-IgM existed in the patients suffering from cirrhosis and chronic hepatitis, the combination of free AFP and AFP-IgM could significantly increase specificity and decrease false negative and/or false positive in the primary HCC at early stages.

Maternal Glucose at 28 Weeks of Gestation Is Not Associated With Obesity in 2-Year-Old Offspring

“…For this article, because of the smaller numbers enrolled in a single center, the upper two OGTT glucose strata were combined, leaving six categories of glucose at each of the three time points. In addition, the area under the curve of the maternal OGTT was calculated (13). …”

Diagnostic and prognostic role of SCCA‐IgM serum levels in hepatocellular carcinoma (HCC)

“…1 The discovery of a novel class of tumor markers constituted by circulating IgM antibodies forming immune complexes with specific cancer biomarkers has provided interesting opportunities for HCC patient management. [8][9][10][11][12][13][14][15][16][17][18][19] IgM immune complexes can be detected in the serum of HCC patients as reported for squamous cell carcinoma antigen (SCCA), [9][10][11][12][13]15 for AFP [15][16][17][18] and for DCP, 19 and the assessment of AFP-IgM, DCP-IgM and SCCA-IgM immune complexes has allowed a higher diagnostic performance than the determination of the free, not complexed, biomarker. According to the revised hypothesis of cancer immune surveillance, 20 these immune-complexed biomarkers might be involved in cancer immune-editing, reflecting the host immune-protective mechanisms, aimed at suppressing tumor growth.…”

The crossroads between cancer immunity and autoimmunity antibodies to self antigens

“…On the other hand, a study reported that HCC patients having anti-p53 autoantibodies had higher survival rate without recurrence (286). In addition, autoantibodies to α-fetoprotein were more prevalent in HCC patients © 1996-2017 than in healthy donors or liver cirrhosis and chronic hepatitis patients (287,288).…”