Clinical evaluation of lentil lectin-reactive alpha-fetoprotein-L3 in histology-proven hepatocellular carcinoma

Introduction: Serum alpha-fetoprotein (AFP) is a useful marker of hepatocel lular carcinoma (HCC), although the serum AFP concentration is also increas ed in patients with chronic liver diseases (CLD). The analysis of AFP glyco -forms has been known to be of diagnostic value. We applied the lectin-affi nity electrophoresis and antibody-affinity blotting techniques to HCC patie nts in Vietnam in order to better understand the role of lentil lectin-affi nity AFP-L3 in the diagnosis and differential diagnosis of HCC, and its rel ationship with the biological characteristics of HCC. Methods: Lens culinaris agglutinin-reactive AFP (AFP-L3) was measured in 65 patients with histologically proven HCC and 25 patients with CLD. All pati ents had serum AFP levels above 54 ng/mL. AFP-LS levels were determined by lectin affinity electrophoresis coupled with antibody-affinity blotting. Th e diagnosis of HCC was confirmed histologically by ultrasound-guided biopsy . Results: The mean value of AFP-L3 in the HCC patients was 49.6 +/- 21.6%, w hich was significantly higher (p <0.001) than that in the 25 CLD patients ( 10.7 +/- 4.3%). When the cutoff level for AFP-L3 was set at 15% (mean +/- S D), the sensitivity was 96.9%, the specificity 92.0% and the accuracy 95.5% in the 65 HCC patients. There was no clear correlation between serum AFP l evel and AFP-L3 percentage (r=0.16). There was no correlation between AFP-L 3 and the maximum diameter of HCC nodules (r=0.05). However, the mean AFP-L 3 value was higher in moderately or poorly differentiated HCC than in well differentiated tumors (p <0.001). Conclusions: AFP-L3 is potentially a clinically useful marker for the diffe rentiation of increased AFP levels in hepatocellular carcinoma and chronic liver diseases. The AFP-L3 percentage is closely related to HCC differentia tion. We consider the analysis of AFP-L3 a useful adjunct in the diagnosis of HCC.