Usefulness of Lens culinaris agglutinin A-reactive fraction of alpha-fetoprotein (AFP-L3) as a marker of distant metastasis from hepatocellular carcinoma

The objective of this study was to clarify the relationship between the ser um level of the Lens culinaris agglutinin A-reactive fraction of alpha-feto protein (AFP-L3) and the clinical features including sex, age, Child's clas sification, virus markers, tumour size, tumour stage, distant metastasis, h istopathologic findings, portal thrombus and outcome of hepatocellular carc inoma (HCC). We measured the AFP-L3 levels in 170 HCC cases at the time of diagnosis using lectin-affinity electrophoresis followed by antibody-affini ty blotting. The patients were divided into two groups, those who were AFP- L3 positive (n=56; AFP-L3 greater than or equal to 15% relative to the tota l alpha-fetoprotein (AFP) concentration) and those who were AFP-L3 negative (n=114; AFP-L3 <15%). Then we examined the association between the serum A FP-L3 level and the clinical features of HCC. No significant differences we re found in age, sex, and virus markers between the AFP-L3-positive and -ne gative groups. However, patients in the positive group had worse liver func tion and larger tumours compared to the negative group. They also had more advanced cancer with poor tumour histology compared to the negative group. Distant metastasis was diagnosed significantly more often in the positive g roup than that in the negative group. There was no significant correlation between the AFP-L3 level and portal thrombus. Although the follow-up period was brief the prognosis for the positive group clearly was poor. These res ults suggest that AFP-L3 is a useful indicator of distant metastasis and a poor prognosis for HCC.