Prognostic importance of fucosylated alpha-fetoprotein in hepatocellular carcinoma patients with low alpha-fetoprotein
Article first published online: 14 JUN 2011
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 26, Issue 7, pages 1195–1200, July 2011
How to Cite
Nouso, K., Kobayashi, Y., Nakamura, S., Kobayashi, S., Takayama, H., Toshimori, J., Kuwaki, K., Hagihara, H., Onishi, H., Miyake, Y., Ikeda, F., Shiraha, H., Takaki, A., Iwasaki, Y., Kobashi, H. and Yamamoto, K. (2011), Prognostic importance of fucosylated alpha-fetoprotein in hepatocellular carcinoma patients with low alpha-fetoprotein. Journal of Gastroenterology and Hepatology, 26: 1195–1200. doi: 10.1111/j.1440-1746.2011.06720.x
- Issue published online: 14 JUN 2011
- Article first published online: 14 JUN 2011
- Accepted manuscript online: 16 MAR 2011 08:25PM EST
- Accepted for publication 6 March 2011.
- hepatocellular carcinoma
Background and Aim: Fucosylated alpha-fetoprotein (AFP-L3) is known to be a marker of poor prognosis in patients with hepatocellular carcinoma (HCC). However, it has been difficult to measure AFP-L3 under low AFP (≤ 20 ng/mL). The aim of this study was to elucidate the role of AFP-L3 in HCC patients with low AFP conditions.
Methods: One hundred and ninety six consecutive newly developed HCC patients with low AFP (≤ 20 ng/mL) were examined for serum AFP-L3 expression by a newly-developed micro-total analysis system that could stably measure AFP-L3 in low AFP circumstances, and its clinical importance was analyzed.
Results: Positivity of AFP-L3 in HCC patients was 13.3% at a cut-off level of 10%. Five-year survivals of HCC patients with AFP-L3 (< 10%) and AFP-L3 (≥ 10%) were 69.4% and 41.1%, respectively (P = 0.001). Among 18 clinical parameters, low alanine aminotransferase, large tumor size, presence of portal vein tumor thrombus, high AFP and high des-gamma carboxy prothrombin were observed in the high AFP-L3 (≥ 10%) group. Multivariate analysis revealed that high aspartate aminotransferase (AST) (risk ratio [RR] = 3.24, 95% confidence interval [CI] = 1.27–8.26), the presence of ascites (RR = 3.44, 95% CI = 1.22–9.34), multiple tumor number (RR = 3.06, 95% CI = 1.33–7.17), and high AFP-L3 (RR = 8.36, 95% CI = 2.79–25.5) were risk factors for survival. High AFP-L3 was also a risk factor for survival in HCC patients who received radiofrequency ablation (P = 0.048).
Conclusions: AFP-L3 is a strong prognostic factor for survival even in HCC patients with low AFP (≤ 20 ng/mL).