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Clinicopathologic features of patients with primary malignant hepatic tumors seropositive for α-fetoprotein-L3 alone in comparison with other patients seropositive for α-fetoprotein-L3

Authors


Hiroaki Okuda, MD, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Email: ohiroaki@aol.com

Abstract

Background:  Patients with hepatocellular carcinoma (HCC) seropositive for lectin-reactive α-fetoprotein (AFP-L3) have a poor prognosis. However, there have been no studies of the clinicopathologic features of patients seronegative for both AFP and des-γ-carboxy prothrombin (DCP), and seropositive for AFP-L3 alone in comparison with other patients seropositive for AFP-L3.

Methods:  Patients with primary malignant hepatic tumors seropositive for AFP-L3 who underwent hepatectomy (n = 84) were divided into four groups, and their clinicopathologic features were compared: (i) group A, seronegative for AFP <100 ng/mL and DCP <40 mAU/mL; (ii) group B, seropositive for AFP ≥100 ng/mL and seronegative for DCP; (iii) group C, seronegative for AFP and seropositive for DCP ≥40 mAU/mL; and (iv) group D, seropositive for AFP and DCP.

Results:  Among the 14 group A patients seropositive for AFP-L3 alone with low AFP concentrations, three had intrahepatic cholangiocarcinoma (ICC), one had a cholangiolocellular carcinoma, one had combined HCC and ICC, and one had undifferentiated hepatic sarcoma. Group A had a higher incidence of non-HCC tumors (< 0.001) and tumors derived from cholangiocytes (< 0.001) than the other three groups. They also had a high frequency of poorly differentiated tumors and sarcomatous changes, and showed a poor prognosis.

Conclusions:  Patients with primary malignant hepatic tumors seropositive for AFP-L3 alone with low AFP concentrations have unique clinicopathologic features. Thus, we should be aware of these patients and should measure AFP-L3 levels, at least once, even in those seronegative for both AFP and DCP.

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