2,131 coded sera were obtained and tested according to the new 5'-NPDase-V isozyme test. On decoding, 99/126 (79%) samples of primary hepatoma, from the United States and other countries, were positive.
In the U. S. group, 51/58 (88%) were positive, 23/58 (40%) had AFP higher than 20 ng/ml. In the non-U. S. group, 48/68 (71%) were positive for 5'-NPDase-V, ascompared with AFPelevation in 45/68 (66%). 236/268 (88%) cases of cancer with known liver metastases were positive for 5'-NPDase-V. Of 1,040 cancer patients without liver scan or biopsy evidence of metastasis, 316 were positive. In a follow-up of this group of 316 cases, 109 underlying liver metastases were demonstrated by repeat scan or at autopsy within 3-6 months. All 166 sera from normal healthy persons were negative for 5'-NPDase-V. Based on this large panel, 5'-NPDase-V test is a sensitive and an important diagnostic aid for cancer patients, both as an early predictor for liver metastases, and a useful marker for primary hepatoma when no other primary sites are found and when there is no evidence of severe chronic liver disease such as cirrhosis.
Cancer 45209-213, 1980.
HILE PRIMARY CANCER of the liver is considered relatively rare in the United States, the actual number is not low. By the estimate of the American Cancer S ~c i e t y , ~ 1 1,800 cases were found in 1977, and about 9,800 deaths. The mortality rate is therefore close to that of bladder cancer and is only slightly less than half of that prostatic cancer. Hence, it carries an extremely poor prognosis. At the University of Pennsylvania Hospital, we could find only one five year survival in the 20 year period from 1950 to 1970.
Metastatic cancer of the liver from other sites, on the other hand, is very common. The American Cancer Society estimates the incidence as about 20 times that of primary hepatoma. In an extensive study of 1000 consecutive autopsy cases of cancer death, Abrams, Shapiro, and Goldstein2 reported in 1950 that liver metastases were present in 49%. A recent study of over