Skip to main content

Advertisement

SpringerLink
Log in

Lens Culinaris Agglutinin-Reactive Fraction of Alpha-Fetoprotein as a Marker of Prognosis and a Monitor of Recurrence of Hepatocellular Carcinoma After Curative Liver Resection

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to determine the role of Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) as a prognostic marker and a monitor marker of recurrence after curative resection of hepatocellular carcinoma (HCC).

Methods

From December 2002 to May 2004, 395 consecutive patients with HCC who underwent curative partial hepatectomy were included in the study. The tumor characteristics and clinical outcomes of patients with positive preoperative and postoperative AFP-L3 were compared with those with negative results.

Results

A high ratio of AFP-L3 to total AFP was an indicator of pathologic aggressiveness. Patients with positive preoperative AFP-L3 had significantly earlier recurrence (median time to recurrence 22.0 ± 2.4 months vs 45.0 ± 6.9 months, P < .001) when compared with those with negative preoperative results. Significantly more patients with continuously positive or negative-turn-positive AFP-L3 results after surgery developed recurrence, particularly distant metastases, when compared with patients with continuously negative AFP-L3 results. The overall and disease-free survivals were significantly shorter in the positive than the negative preoperative AFP-L3 group. The overall and disease-free survivals were significantly shorter in the continuously positive and the negative-turn-positive than the continuously negative postoperative AFP-L3 group.

Conclusion

Positive preoperative AFP-L3 and continuously positive or negative-turn-positive AFP-L3 results after surgery predicted a more aggressive tumor behavior, higher tumor recurrence, and poorer clinical outcomes. HCC patients with an increased proportion of AFP-L3 to total AFP should be more aggressively treated and closely followed-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lau WY. Management of hepatocellular carcinoma. J R Coll Surg Edinb. 2002;47:389–99.

    PubMed  CAS  Google Scholar 

  2. Lai EC, Lau WY. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005;3:210–5.

    Article  PubMed  CAS  Google Scholar 

  3. Lau WY. Primary hepatocellular carcinoma. In: Blumgart LH, Fong Y, eds. Surgery of the liver and biliary tract. Vol. 2. London: WB Saunders; 2000. p. 1423–50.

    Google Scholar 

  4. Liaw YF, Tai DI, Chu CM, Lin DY, Sheen IS, Chen TJ, et al. Early detection of hepatocellular carcinoma in patients with chronic type B hepatitis: a prospective study. Gastroenterology. 1986;90:263–7.

    PubMed  CAS  Google Scholar 

  5. Debruyne EN, Delanghe JR. Diagnosing and monitoring hepatocellular carcinoma with alpha-fetoprotein: new aspects and applications. Clin Chim Acta. 2008;395:19–26.

    Article  PubMed  CAS  Google Scholar 

  6. Oka H, Tamori A, Kuroki T, Kobayashi K, Yamamoto S. Prospective study of alpha-fetoprotein in cirrhotic patients monitored for development of hepatocellular carcinoma. Hepatology. 1994;19:61–6.

    Article  PubMed  CAS  Google Scholar 

  7. Chu CW, Hwang SJ, Luo JC, Lai CR, Tsay SH, Li CP, et al. Clinical, virologic, and pathologic significance of elevated serum alpha-fetoprotein levels in patients with chronic hepatitis C. J Clin Gastroenterol. 2001;32:240–4.

    Article  PubMed  CAS  Google Scholar 

  8. Farinati F, Marino D, De Giorgio M, Baldan A, Cantarini M, Cursaro C, et al. Diagnostic and prognostic role of alpha-fetoprotein in hepatocellular carcinoma: both or neither? Am J Gastroenterol. 2006;101:524–32.

    Article  PubMed  CAS  Google Scholar 

  9. Paul SB, Gulati MS, Sreenivas V, Madan K, Gupta AK, Mukhopadhyay S, et al. Evaluating patients with cirrhosis for hepatocellular carcinoma: value of clinical symptomatology, imaging and alpha-fetoprotein. Oncology. 2007;72:S117–23.

    Article  Google Scholar 

  10. Li D, Mallory T, Satomura S. AFP-L3: a new generation of tumor marker for hepatocellular carcinoma. Clin Chim Acta. 2001;313:15–9.

    Article  PubMed  CAS  Google Scholar 

  11. Sato Y, Nakata K, Kato Y, Shima M, Ishii N, Koji T, et al. Early recognition of hepatocellular carcinoma based on altered profiles of alpha-fetoprotein. N Engl J Med. 1993;328:1802–6.

    Article  PubMed  CAS  Google Scholar 

  12. Taketa K, Endo Y, Sekiya C, Tanikawa K, Koji T, Taga H, et al. A collaborative study for the evaluation of lectin-reactive alpha-fetoproteins in early detection of hepatocellular carcinoma. Cancer Res. 1993;53:5419–23.

    PubMed  CAS  Google Scholar 

  13. Marrero JA, Feng Z, Wang Y, Nguyen MH, Befeler AS, Roberts LR, et al. Alpha-fetoprotein, des-gamma carboxyprothrombin, and lectin-bound alpha-fetoprotein in early hepatocellular carcinoma. Gastroenterology. 2009;137:110–8.

    Article  PubMed  CAS  Google Scholar 

  14. Yamashita F, Tanaka M, Satomura S, Tanikawa K. Prognostic significance of Lens culinaris agglutinin A-reactive alpha-fetoprotein in small hepatocellular carcinomas. Gastroenterology. 1996;111:996–1001.

    Article  PubMed  CAS  Google Scholar 

  15. Yamashiki N, Seki T, Wakabayashi M, Nakagawa T, Imamura M, Tamai T, et al. Usefulness of Lens culinaris agglutinin A-reactive fraction of alpha-fetoprotein (AFP-L3) as a marker of distant metastasis from hepatocellular carcinoma. Oncol Rep. 1999;6:1229–32.

    PubMed  CAS  Google Scholar 

  16. Hayashi K, Kumada T, Nakano S, Takeda I, Sugiyama K, Kiriyama S, et al. Usefulness of measurement of Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein as a marker of prognosis and recurrence of small hepatocellular carcinoma. Am J Gastroenterol. 1999;94:3028–33.

    PubMed  CAS  Google Scholar 

  17. Tateishi R, Shiina S, Yoshida H, Teratani T, Obi S, Yamashiki N, et al. Prediction of recurrence of hepatocellular carcinoma after curative ablation using three tumor markers. Hepatology. 2006;44:1518–27.

    Article  PubMed  CAS  Google Scholar 

  18. Tada T, Kumada T, Toyoda H, Kiriyama S, Sone Y, Tanikawa M, et al. Relationship between Lens culinaris agglutinin-reactive alpha-fetoprotein and pathologic features of hepatocellular carcinoma. Liver Int. 2005;25:848–53.

    Article  PubMed  CAS  Google Scholar 

  19. Miyaaki H, Nakashima O, Kurogi M, Eguchi K, Kojiro M. Lens culinaris agglutinin-reactive alpha-fetoprotein and protein induced by vitamin K absence II are potential indicators of a poor prognosis: a histopathological study of surgically resected hepatocellular carcinoma. J Gastroenterol. 2007;42:962–8.

    Article  PubMed  CAS  Google Scholar 

  20. Shiraki K, Takase K, Tameda Y, Hamada M, Kosaka Y, Nakano T. A clinical study of lectin-reactive alpha-fetoprotein as an early indicator of hepatocellular carcinoma in the follow-up of cirrhotic patients. Hepatology. 1995;22:802–7.

    Article  PubMed  CAS  Google Scholar 

  21. Kobayashi M, Kuroiwa T, Suda T, Tamura Y, Kawai H, Igarashi M, et al. Fucosylated fraction of alpha-fetoprotein, L3, as a useful prognostic factor in patients with hepatocellular carcinoma with special reference to low concentrations of serum alpha-fetoprotein. Hepatol Res. 2007;37:914–22.

    Article  PubMed  CAS  Google Scholar 

  22. Lau WY, Lai EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg. 2009;249:20–5.

    Article  PubMed  Google Scholar 

  23. Jonas S, Steinmüller T, Settmacher U, Langrehr J, Müller A, Neuhaus P. Liver transplantation for recurrent hepatocellular carcinoma in Europe. J Hepatobiliary Pancreat Surg. 2001;8:422–6.

    Article  PubMed  CAS  Google Scholar 

  24. Dalton RR, Eisenberg BL. Surgical management of recurrent liver tumors. Semin Oncol. 1993;20:493–505.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgement

Funding Supported by the National High Technology Research and Development Program of China (No. 2007AA02Z461), China National Key Projects for Infectious Disease (No. 2008ZX10002-021), and the National Natural Science Foundation of China (No. 30772513).

Author information

Authors and Affiliations

  1. Molecular Oncology Laboratory, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People’s Republic of China

    Xiao-Feng Zhang MD, Xiao-Yan Kang MD, Hai-Hua Qian BS, Yan-Ming Zhou MD, PhD, Yu Zhang MS, Meng-Chao Wu MD & Zheng-Feng Yin MD, PhD

  2. Department of Comprehensive Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People’s Republic of China

    Xiao-Feng Zhang MD, Eric C. H. Lai MBChB, MRCS, FRACS, Le-Hua Shi MD, PhD, Feng Shen MD, PhD, Ye-Fa Yang MD, PhD, Wan Yee Lau MD, FRCS, FACS, FRACS (Hon) & Meng-Chao Wu MD

  3. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories , Hong Kong SAR, People’s Republic of China

    Eric C. H. Lai MBChB, MRCS, FRACS & Wan Yee Lau MD, FRCS, FACS, FRACS (Hon)

  4. Department of Hepato-Biliary-Pancreato-Vascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China

    Yan-Ming Zhou MD, PhD

Authors
  1. Xiao-Feng Zhang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric C. H. Lai MBChB, MRCS, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiao-Yan Kang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hai-Hua Qian BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yan-Ming Zhou MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Le-Hua Shi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Feng Shen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ye-Fa Yang MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yu Zhang MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wan Yee Lau MD, FRCS, FACS, FRACS (Hon)
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Meng-Chao Wu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Zheng-Feng Yin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zheng-Feng Yin MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, XF., Lai, E.C.H., Kang, XY. et al. Lens Culinaris Agglutinin-Reactive Fraction of Alpha-Fetoprotein as a Marker of Prognosis and a Monitor of Recurrence of Hepatocellular Carcinoma After Curative Liver Resection. Ann Surg Oncol 18, 2218–2223 (2011). https://doi.org/10.1245/s10434-011-1613-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1613-7

Keywords

Search

Navigation