Monitoring hepatocellular carcinoma by using a monoclonal immunoenzymometric assay alpha-fetoprotein

M. L. Kelsten, D. W. Chan, D. J. Bruzek, R. C. Rock

Research output: Contribution to journalArticle

Abstract

A monoclonal immunoenzymometric assay for alpha-fetoprotein (M-AFP) was evaluated with respect to its utility in monitoring hepatocellular carcinoma (HCC) patients. Earlier (Clin Chem 1986;32:1318-22), we found this immunoassay to demonstrate abilities similar to polyclonal AFP assays, and we suggested that changes in M-AFP correlated with changes in intrahepatic tumor volume in most HCC patients. In the present study, 107 HCC patients were evaluated between 1978 and 1986. Patient demographics characterized the study population as being similar to those seen in regions with low incidence of HCC. Changes in serum M-AFP concentration correlated moderately (r = 0.55) with changes in intrahepatic tumor volume. The AFP concentration in serum was found to be a statistically significant independent predictor of survival; patients with above-normal M-AFP (AFP[+]) at presentation demonstrated a median survival time of 10 months, compared with 16 months for patients with 'normal' values for M-AFP (AFP[-]) (P = 0.008). This prognostic pattern persisted when adjusted for serum bilirubin concentration (AFP[+] 12 months vs AFP[-] 29 months, P = 0.01). Hepatocellular carcinoma (HCC) is a disease of major epidemiological importance because of its high prevalence in certain parts of the world and its association with hepatitis B virus (HBV). In addition, its high mortality rates make prevention an especially desirable goal. The incidence of HCC varies considerably in different parts of the world. It is most common in Africa and the Far East (3-8), and there are geographic variations in incidence by sex and age. The various factors associated with HCC - hepatitis B virus, aflatoxin, and cirrhosis (of any cause) - in different parts of the world suggest a multifactorial etiology. Serum alpha-fetoprotein (AFP), the major protein in fetal circulation during early life, increases above the low concentrations seen in normal adults in various disease stated, including hepatic neoplasms (primary and metastatic), germ-cell tumors, hepatitis, and cirrhosis. The development of quantitative immunoassays for AFP that are sufficiently sensitive to allow detection of AFP in normal serum has had one unfortunate consequence: non-specificity in distinquishing between malignant and nonmalignant causes of moderately increased AFP concentrations.

Original languageEnglish (US)
Pages (from-to)76-81
Number of pages6
JournalClinical chemistry
Volume34
Issue number1
StatePublished - Jan 1 1988

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

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