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Prognostic importance of fucosylated alpha‐fetoprotein in hepatocellular carcinoma patients with low alpha‐fetoprotein
Author(s) -
Nouso Kazuhiro,
Kobayashi Yoshiyuki,
Nakamura Shinichiro,
Kobayashi Sayo,
Takayama Hiroki,
Toshimori Junichi,
Kuwaki Kenji,
Hagihara Hiroaki,
Onishi Hideki,
Miyake Yasuhiro,
Ikeda Fusao,
Shiraha Hidenori,
Takaki Akinobu,
Iwasaki Yoshiaki,
Kobashi Haruhiko,
Yamamoto Kazuhide
Publication year - 2011
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2011.06720.x
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , alpha fetoprotein , ascites , relative risk , confidence interval , carcinoma
Abstract 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).