A CLINICAL-STUDY OF LECTIN-REACTIVE ALPHA-FETOPROTEIN AS AN EARLY INDICATOR OF HEPATOCELLULAR-CARCINOMA IN THE FOLLOW-UP OF CIRRHOTIC-PATIENTS

Levels of two types of lectin-reactive alpha-fetoprotein (AFP), design ated AFP-L3 and AFP-P4+-P5, were analyzed with Lens culinaris agglutin in A and AFP-P4+P5 with erythroagglutinating phytohemagglutinin, respe ctively, in an attempt to determine the utility and significance of th ese macromolecules as early indicators of hepatocellular carcinoma dur ing the periodic follow-up of cirrhotic patients. The subjects were 51 of 190 consecutive cirrhotic patients in whom hepatocellular carcinom a developed during a 6-year follow-up period and 21 cirrhotic patients without hepatocellular carcinoma. Serum AFP levels were of limited va lue to diagnose and predict hepatocellular carcinoma. The relative lev els of AFP-L3 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 hepatocell ular carcinomas less than 2 cm in diameter showed elevated percentage of lectin-reactive APP. Retrospective examination of 21 patients who w ere positive for lectin-reactive AFP at diagnosis of hepatocellular ca rcinoma showed that 41% of them had already expressed lectin-reactive AFP 12 months before the direct detection of hepatocellular carcinoma by diagnostic imaging. These results lead us to conclude that the leve l of lectin-reactive AFP is a suitable predictive marker for the early recognition of hepatocellular carcinoma in the followup of patients w ith cirrhosis, and that measurements of the level of lectin-reactive A FP should be added to the screening methods that are now in use.