Serum alpha-L-fucosidase activity and early detection of hepatocellular carcinoma - A prospective study of patients with cirrhosis

BACKGROUND. Serum alpha-L-fucosidase activity is considered a marker of hep atocellular carcinoma. To the authors' knowledge, its clinical usefulness i n the early detection of hepatocellular carcinoma in the follow-up of cirrh otic patients has not been reported previously. METHODS. The authors prospectively studied serum alpha-L-fucosidase activit y in addition to alpha-fetoprotein and ultrasonography, in a regular screen ing of 132 cirrhotic patients during an 8-year follow-up. RESULTS. At enrollment, 120 patients had low alpha-L-fucosidase activity (b elow the cutoff value) and 12 had high activity, All patients had serum alp ha-fetoprotein levels below the cutoff value. During the follow-up, hepatoc ellular carcinoma was detected in 19 patients, 16 with alpha-L-fucosidase a ctivity below the cutoff value at enrollment and 3 with activity above it. In 7 of those 16 patients with carcinoma and low enzyme activity, the enzym e activity showed a significant increase 6-9 months before there was ultras onographic evidence of a focal lesion, and by the time of diagnosis it had risen above the cutoff value in all of them; in only 3 of the 7 patients wa s the increase in cr-l-fucosidase activity associated with an increase in a lpha-fetoprotein. In another 4 of the 19 patients with carcinoma, only alph a-fetoprotein increased. CONCLUSIONS. Serum alpha-L-fucosidase activity is useful in the early detec tion of hepatocellular carcinoma. The data from this study suggest that cir rhotic patients who have a marked increase in serum alpha-L-fucosidase leve ls during follow-up should be closely monitored for signs of hepatocellular carcinoma development. Cancer 1998;83:2468-74. (C) 1998 American Cancer So ciety.