Highly sensitive Lens culinaris agglutinin-reactive fraction of -fetoprotein is a predictive marker for hepatocarcinogenesis in long-term observation of patients with chronic liver disease

Highly sensitive Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (hs-AFP-L3) is a specific marker for hepatocellular carcinoma (HCC) and has been reliable in cases with a low serum alpha-fctoprotein (AFP) level. However, the biomarkers that contribute to hepatocarcinogenesis during the long-term observation are not yet clear. The present study reported the clinical utility of hs-AFP-L3 in the long-term observation of patients with chronic liver disease. The subjects were 106 patients with chronic liver disease without HCC or a history of HCC treatment and who had been followed for >12 months. hs-AFP-L3 was measured using cryopreserved serum. The factors contributing to hepatocarcinogenesis were examined using univariate and multivariate analyses. The median observation period was 88 months (15-132 months). The cumulative incidence of HCC was 10.5% at 5 years and 19.6% at 10 years. The univariate analysis revealed that age >= 55 years old, platelet count <= 1.3.1x10(4)/mu l, hyaluronic acid >= 80.8 ng/ml, alanine transaminase >= 47 U/l, AFP >= 6.3 ng/ml, hs-AFP-L3 >= 3.5% and des-gamma-carboxy prothrombin (DCP) >= 25 mAU/ml were significant factors. In the multivariate analysis, platelet count <= 13.1x10(4)/mu l [hazard ratio (HR), 4.966; 95% confidence interval (CI), 1.597-15.437; P=0.006] and hs-AFP-L3 >= 3.5% (HR, 5.450; 95% CI, 1.522-19.512; P=0.009) were extracted as significant factors contributing to hepatocarcinogenesis. In addition, for cases with AFP <20 ng/ml, a multivariate analysis revealed that hs-AFP-L3 >= 4.9% (HR, 11.608; 95% CI, 2.422-55.629; P=0.002) and DCP >= 25 mAU/ml (HR, 3.936; 95% CI, 1.088-14.231; P=0.037) were significant factors contributing to hepatocarcinogenesis. hs-AFP-L3 is a useful marker for predicting hepatocarcinogenesis in the long-term observation of patients with chronic liver disease.