Alpha Fetoprotein, AFP-L3 and PIVKA-II in patients with

Hepatic Cirrhosis and Hepatocellular Carcinoma

Siraj ahmed khan, Bhavya s ,iyyapu Krishna mohan , sreedevi N, sheshu kumar, Vijay
bhasker, KSS saibaba
Nizam’s Institute of Medical Sciences
Background and Aim: Hepatocellular carcinoma (HCC) is a common
complication in patients with Hepatic Cirrhosis. Detection of HCC at an
early stage is critical for a favourable clinical outcome. The study aim was
to: (i) compare the levels of α -fetoprotein (AFP), AFP-L3 and Protein
Induced by Vitamin K Absence II in HCC patients and in hepatitis
cirrhosis patients without HCC; (ii) to define the level of each tumor
marker with the best sensitivity and specificity for HCC diagnosis; and
(iii) to correlate the levels of these markers with respect to disease
severity.

Methods: The study group consisted of 60 patients - 30 HCC, 30 HC; and

30 healthy subjects. All evaluated for AFP-L3, PIVKA-II and Total AFP
(T.AFP).

Results: Levels of DCP, AFP and AFP L-3 were significantly higher in
patients with HCC than in those without HCC (P < 0.0001). Receiver–
operating curves (ROC) indicated that the cut-off value with the best
sensitivity and specificity was 6.715 ng/ml for PIVKA-II, 12.2 ng/mL for
T.AFP and 1.05 ng/ml for AFP-L3. The sensitivity and specificity for
AFP-L3 was 90% and 86%; PIVKA-II 85.71% and 95%; and for T.AFP
70% and 94% respectively. The AUROC was 0.910, 0.870 and 0.820 for
AFP-L3, PIVKA-II and T.AFP respectively.
When all 3 markers combined AUROC increased to 0.943.
Also, there was strong positive correlation of AFP-L3 and PIVKA-II
levels with tumour size (P = 0.0001, P = 0.043), while no such significant
association was found with T.AFP.

Conclusion:
AFP-L3 had the highest sensitivity and AUC for HCC diagnosis, had a
direct correlation with tumor size. Hence AFP-L3 should be used as the
main serum test for HCC detection.

Key words
AFP L3, DCP, AFP,