Prognostic significance of Lens culinaris agglutinin A-reactive alpha-fetoprotein in small hepatocellular carcinomas

Background & Aims: Lens culinaris agglutinin A-reactive fraction of alpha-fetoprotein (AFP-L3) has been reported to be a useful marker in the early diagnosis of hepatocellular carcinoma (HCC), The aim of this study was to evaluate the prognostic value of AFP-L3 for HCC, Methods: Fifty-five patients with HCC whose AFP-L3 levels were negative before initial therapy were studied, AFP-L3 levels were measured by lectin-affinity electrophoresis coupled with antibody-affinity blotting. Results: Of the 55 patients, 28, 15, and 12 underwent percutaneous ethanol injection, transcatheter arterial embolization, and hepatectomy, respectively. Thirty-two (58.2%) of the 55 patients maintained a negative AFP-L3 status during the study, and 23 patients (41.8%) became positive for AFP-L3 during posttreatment observation, Multiple recurrences of HCC and portal vein tumor thrombus were observed significantly more often in patients with positive AFP-L3 than in those with negative AFP-LS status (P < 0.0001). In contrast, most patients with negative AFP-LB had solitary recurrences of HCC without portal vein tumor thrombus, Overall survival was significantly lower in patients with positive AFP-L3 than in those with negative AFP-LB status (P = 0.0006), Cox's proportional hazards model identified that AFP-LB was an independent prognostic factor (P = 0.0005), Conclusions: AFP-L3 seems to be a significant marker of poor prognosis for HCC.