Early recognition of hepatocellular carcinoma based on altered profiles of alpha-fetoprotein

Biochemical characterization of bovine alpha-fetoprotein and comparison with human alpha-fetoprotein

This study compares the molecular, charge and lectin microheterogeneity of bovine alpha-fetoprotein (bAFP) with human (h) AFP. Molecular weights of bAFP (81 kDa) and hAFP (69 kDa) were detected by Western immunoblotting. Marked crossreactivity was found between bAFP and hAFP by Western immunoblotting but no crossreactivity was noticed by radioimmunoassays. At least seven charge isoforms of bAFP and three isoforms of hAFP were consistently detected by chromatofocusing in a mixture of fetal bovine serum (FBS) and human cord blood (hCB), while only three isoforms of bAFP and hAFP were detected in a mixture of bovine (bAF) and human amniotic fluid (hAF). Using concanavalin A (Con A) chromatography, 50% of bAFP was Con A reactive and 50% non-reactive, while more than 98% of hAFP was Con A reactive in a mixture of FBS and hCB. However, in AFs, 72% of bAFP was Con A reactive, while 89% of hAFP was Con A reactive. These data indicate that marked differences exist in both the charge and lectin microheterogeneity of bovine and human AFP.

Detection of hepatocellular carcinoma-specific alpha-fetoprotein by isoelectric focusing

BACKGROUND

Serum alpha-fetoprotein (AFP) is elevated in up to 80% of patients with hepatocellular carcinoma (HCC). Modestly raised AFP levels (10-400 ng/ml) are also found in patients with nonmalignant liver diseases. In the present study, isoelectric focusing of AFP was used to differentiate the AFP found in patients with HCC.

METHODS

To establish the assay conditions, isoelectric focusing was performed on sera from 14 patients with HCC and 13 with nonmalignant liver diseases. Sera was also analyzed under coded conditions from 16 patients with HCC, 14 with chronic active hepatitis (CAH), and 6 with cirrhosis to determine the specificity and sensitivity of the assay in the diagnosis of HCC.

RESULTS

Isoelectric focusing of sera from patients with HCC and various non malignant liver diseases identified AFP variants (AFP I-IV). All 14 patients with HCC had AFP variants I and III, and 7 of the 14 also had variant IV. When analyzed in the coded study 13 of the 16 cases of HCC were predicted correctly by the presence of AFP variants III or III and IV. AFP bands III and IV were not discernible in 12 of the 14 patients with CAH and 4 of the 6 with cirrhosis.

CONCLUSION

Isoelectric focusing of sera from patients with HCC and nonmalignant liver disease identified two AFP variants apparently specific for HCC. In the setting of borderline elevation of AFP, this technique has a sensitivity of 81% and specificity of 85% for detecting the presence of bands III or IV and may prove suitable for use in a routine laboratory as a screening assay.

Treatment of hepatocellular carcinoma with transcatheter arterial embolization. Analysis of prognostic factors

BACKGROUND

Transcatheter arterial embolization (TAE) is a useful treatment modality for hepatocellular carcinoma (HCC). To study the prognostic factors, survival time of patients with HCC after TAE was analyzed retrospectively using clinical manifestations of coexisting liver cirrhosis and clinical features of HCC.

METHODS

Eighty-seven patients with HCC were treated with TAE between 1984 and 1991 and observed at Nagasaki University Hospital. All the patients also had liver cirrhosis.

RESULTS

The survival time of the 87 patients after TAE ranged from 2 months to 8.1 years (mean +/- standard deviation, 2.7 +/- 0.3 years). Survival curves after TAE did not differ between men and women (P > 0.5) or between hepatitis B and C viral infection (P > 0.8), but they depended on clinical stages of coexisting liver cirrhosis (P < 0.01). The cumulative survival after TAE was significantly longer in patients with uninodular tumors than in patients with multinodular tumors (P < 0.0001) (3-year survival, 53.3% vs. 13.3%; 5-year survival, 32.2% vs. 3.3%, respectively). In contrast, patients' survival time was not associated with the size of the tumor detected at the time of treatment with TAE (P > 0.1).

CONCLUSIONS

Treatment of HCC with TAE is well indicated regardless of tumor size for patients with nonadvanced liver cirrhosis and uninodular tumors. Alternatively, treatment of HCC with TAE alone is still insufficient in patients with multinodular tumors. Other treatment modalities in combination with TAE should be considered to achieve a more favorable prognosis of these patients.

Management options for primary hepatocellular carcinoma. An overview

Hepatocellular carcinoma (HCC) is the seventh most common cancer in men and the ninth most common cancer in women with 500,000 to 1,000,000 new cases per year. Several risk factors (sex hormones, alcohol, thorotrast, aflatoxin B1, hepatitis B or C, haemochromatosis, alpha 1-antitrypsin deficiency, tyrosinemia, porphyria cutanea tarda, acute intermittent porphyria, Wilson's disease) associated with the development of HCC have been identified from epidemiological studies. The diagnosis is usually based on a combination of clinical and laboratory findings together with radiographic and histopathologic characteristics. HCC remains difficult to treat with a median survival of 3 to 6 months after the onset of symptoms. Surgical resection is the mainstay of treatment for HCC. Transcatheter arterial embolization and percutaneous ethanol injection have been used but neither therapy has been evaluated in a prospective randomized study. Combination treatment (e.g. chemotherapy and resection) may be of value but randomized controlled trials with long-term follow-up are still needed. Liver transplantation should be reserved for carefully selected patients.