Clinical significance of AFP-L3 in the diagnosis and treatment of transcather arterial chemoembolization in elderly patients with primary hepatic carcinoma

Abstract

Objective To investigate the clinical significance of alpha-fetoprotein (AFP) variant (AFP-L3), AFP and vascular endothelial growth factor (VEGF) in the diagnosis of elderly primary hepatic carcinoma (PHC) and the treatment of transcatheter arterial chemoembolization (TACE). Methods Sevnty-two cases of elderly hepatic lesions in the second Affiliated Hospital of Fujian Medical University were enrolled.Forty-two cases of PHC elder patients (PHC group), 30 cases of benign tumor of liver (benign tumor liver group) were selected.VEGF was detected by double antibody sandwich ELISA, AFP and AFP-L3 were detected with electrochemical luminescence immunoassay (ECLIA), AFP-L3 was isolated with lens culinaris agglutinin (LCA)-coupled spin column(ACSC). Results The serum levels of AFP and VEGF in hepatic cirrhosis group were significantly higher than those in no cirrhosis group (t=6.38, 12.10, P 5 cm group were higher than those in tumor diameter ≤5 cm group (t=17.30, 10.72, 6.21, P<0.05). The serum levels of AFP, AFP-L3 and VEGF in multiple tumor group were higher than those in tumor single tumor group (t=9.07, 13.83, 9.44, P<0.05). The serum levels of AFP, AFP-L3 and VEGF in PHC group were significantly higher than those in benign tumor of liver group (t=19.06, 17.90, 20.20, P<0.01). The serum level of postoperative AFP was significantly lower than that of preoperative level (q=9.04, P<0.01). The serum level of postoperative VEGF was significantly lower than that of preoperative level(q=11.62, P<0.01). One week and one month after operation, the serum levels of AFP-L3 were lower than that before the surgery level (q=13.30, 9.03, P<0.01). The areas of AFP, AFP-L3, VEGF under the ROC curve in the differential diagnosis of PHC were 0.83, 0.79, 0.68, and the area of AFP-L3 was the largest.The sensitivity and specificity of AFP-L3 were 82.1% and 76.7%, the sensitivity and specificity of AFP were 67.3% and 72.5%, the sensitivity and specificity of VEGF were 59.7% and 80.1%.Compared with the single detection, the sensitivity and specificity of AFP+ AFP-L3 were 94.1% and 55.6%, the sensitivity and specificity of AFP+ AFP-L3+ VEGF were 97.6% and 47.6%. Conclusions The diagnostic value of AFP-L3 is better than that of AFP.The allied combination of serum AFP, AFP-L3 and AFP makes up for the insufficient clinical applications of individual serum makers. Key words: Alpha-fetoprotein heterogeneity 3; Alpha-fetoprotein; Primary hepatic carcinoma