A clinical study of lectin-reactive alpha-fetoprotein as an early indicator of hepatocellular carcinoma in the follow-up of cirrhotic patients
✍ Scribed by Katsuya Shiraki; Koujirou Takase; Yukihiko Tameda; Minoru Hamada; Yoshitane Kosaka; Takeshi Nakano
- Publisher
- John Wiley and Sons
- Year
- 1995
- Tongue
- English
- Weight
- 653 KB
- Volume
- 22
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
Levels of two types of lectin-reactive alpha-fetoprotein (AFP), designated AFP-L3 and AFP-P4+P5, were analyzed with Lens culinaris agglutinin A and AFP-P4+P5 with erythroagglutinating phytohemagglutinin, respectively, in an attempt to determine the utility and significance of these macromolecules as early indicators of hepatocellular carcinoma during the periodic follow-up of cirrhotic patients. The subjects were 51 of 190 consecutive cirrhotic patients in whom hepatocellular carcinoma developed during a 6-year follow-up period and 21 cirrhotic patients without hepatocellular carcinoma. Serum AFP levels were of limited value to diagnose and predict hepatocellular carcinoma. The relative levels of AFP-U and AFP-P4+P5 in patients with hepatocellular carcinoma at the time of tumor detection were significantly higher than those in patients with cirrhosis. The sensitivity was 61%, and the specificity was 90%. Fourteen patients (48%) of 29 patients with small hepatocellular carcinomas less than 2 cm in diameter showed elevated percentage of lectin-reactive AFP. Retrospective examination of 21 patients who were positive for lectinreactive AFP at diagnosis of hepatocellular carcinoma showed that 41% of them had already expressed lectinreactive AFP 12 months before the direct detection of hepatocellular carcinoma by diagnostic imaging. These results lead us to conclude that the level of lectin-reactive AFP is a suitable predictive marker for the early recognition of hepatocellular carcinoma in the followup of patients with cirrhosis, and that measurements of the level of lectin-reactive AFP should be added to the screening methods that are now in use. (HEPATOLOGY 1995;22802-807.)
The annual incidence of hepatocellular carcinoma in patients with chronic liver disease varies from 2% to 7%.1-3 The close association of hepatocellular carcinoma with cirrhosis has long been recognized, and it is recom-Abbreviations: AFP, alpha-fetoprotein; DCP, des-y-carboxy prothrombin.