Clinical significance of AFP-L3 in the diagnosis and treatment of transcather arterial chemoembolization in elderly patients with primary hepatic carcinoma
Abstract：ObjectiveTo 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).MethodsSevnty-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).ResultsThe 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＜0.05）.The serum levels of AFP，AFP-L3 and VEGF in tumor diameter >5cm group were higher than those in tumor diameter ≤5cm 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+AFPL3+VEGF were 97.6% and 47.6%.ConclusionsThe 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.
