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Original Article
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Volume 328:1802-1806 June 24, 1993 Number 25
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Early Recognition of Hepatocellular Carcinoma Based on Altered Profiles of Alpha-Fetoprotein
Yoshiaki Sato, Keisuke Nakata, Yuji Kato, Masayoshi Shima, Nobuko Ishii, Toshihiko Koji, Kazuhisa Taketa, Yasuo Endo, and Shigenobu Nagataki

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ABSTRACT

Background The sugar-chain structures of circulating alpha-fetoprotein in patients with hepatocellular carcinomas differ from those in patients with cirrhosis. We studied the reactivity of alpha-fetoprotein with two lectins, Lens culinaris agglutinin A and erythroagglutinating phytohemagglutinin, to monitor the evolution of hepatocellular carcinoma in patients with cirrhosis.

Methods Among 361 patients with cirrhosis caused mainly by chronic hepatitis B or hepatitis C virus infection, 33 with base-line serum alpha-fetoprotein concentrations >= 30 ng per milliliter were found to have hepatocellular carcinomas during a mean follow-up of 35 months. The lectin-reactive profiles of the alpha-fetoprotein in the serum of these 33 patients were analyzed and compared with those in the serum of 32 patients with cirrhosis who had increased base-line serum alpha-fetoprotein concentrations and were followed for at least 24 months but in whom hepatocellular carcinoma did not develop.

Results At the time of tumor detection, 24 (73 percent) of the 33 patients with cirrhosis and hepatocellular carcinoma had higher percentages of L. culinaris agglutinin A-reactive alpha-fetoprotein (alpha-fetoprotein L3), erythroagglutinating phytohemagglutinin-reactive alpha-fetoprotein (alpha-fetoprotein P4+P5), or both than the 32 patients with cirrhosis but no hepatocellular carcinoma. Among the 24 patients, one or both of the markers were first elevated 3 to 18 months before the hepatocellular carcinoma was detected by imaging techniques.

Conclusions Measurements of the alpha-fetoprotein L3 and alpha-fetoprotein P4+P5 fractions of serum alpha-fetoprotein allow the differentiation of hepatocellular carcinoma from cirrhosis in some cases and serve as predictive markers for the development of hepatocellular carcinoma during the follow-up of patients with cirrhosis.


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From the First Department of Internal Medicine, Nagasaki University School of Medicine (Y.S., K.N., Y.K., M.S., S.N.), and the Health Research Center, Nagasaki University (N.I., T.K.), both in Nagasaki; the Department of Public Health, Okayama University Medical School, Okayama (K.T.); and Sanraku Hospital, Tokyo (Y.E.) -- all in Japan.

Address reprint requests to Dr. Nagataki at the First Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852, Japan.

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