Comparison of AFP-L3 and p53 Antigen Concentration with Alpha-Fetoprotein as Serum Markers for Hepatocellular Carcinoma.

BACKGROUND

Hepatocellular carcinoma (HCC) has the worst prognosis among all major cancers, largely due to the lack of sensitive diagnostic markers. We aimed to compare three HCC tumor markers, alpha-fetoprotein (AFP), p53, and AFP-L3%, to evaluate whether measuring serum p53 levels and AFP-L3% has an additive diagnostic value for detection of HCC.

METHODS

A total of 86 patients with chronic liver diseases were included. HCC was detected in 68 (79.1%) patients. Twenty healthy age-matched volunteers served as healthy controls. Serum concentrations of AFP, AFP-L3, and p53 protein were measured. The correlations between the three markers with status of viral hepatitis, liver function tests, and Child-Pugh scores were determined.

RESULTS

HCC patients showed significantly higher percentages of cirrhosis and Child-Pugh grade C (p < 0.001 and 0.05, respectively) compared with non-HCC group. AFP-L3% and p53 levels were significantly (p < 0.001, 0.0001, respectively) higher in HCC than non-HCC patients. AFP-L3% was found significantly correlated with Child-Pugh classification (p < 0.05) and alkaline phosphatase (p < 0.01). While, p53 significantly correlated with age and HCV positivity. ROC curve analysis showed that the highest specificity and sensitivity of the studied parameters are gained at cutoffs of 15%, 120.5 ng/mL, and 0.14 ng/mL for AFP-L3, AFP, and p53; respectively. Combining AFP-L3 and p53 improved sensitivity to 95.4% with a specificity of 85%.

CONCLUSIONS

No significant correlation was found between AFP, AFP-L3%, and p53; however, the simultaneous determination of the three tumor markers yielded a better diagnostic accuracy and sensitivity in the detection of HCCs than each biomarker alone.