Did AFP-L3 save ultrasonography in community screening?

Area of Science:

• Hepatology
• Oncology
• Biomarker Discovery

Background:

• Elevated serum alpha-fetoprotein (AFP) in community screening necessitates ultrasonography (US) for hepatocellular carcinoma (HCC) detection.
• AFP-L3 has been explored in Japan to distinguish HCC from hepatitis in patients with elevated AFP, but its utility is limited elsewhere.
• This study investigated the role of AFP-L3 in community settings to assess its potential in avoiding unnecessary US examinations.

Purpose of the Study:

• To evaluate the effectiveness of AFP-L3 in differentiating HCC from hepatitis in a community screening population with elevated AFP.
• To determine if AFP-L3 can help reduce the number of unnecessary ultrasonography (US) examinations.

Main Methods:

• A large-scale healthcare screening of 56,702 subjects was conducted in Tainan county.
• Baseline sera from 169 subjects with elevated AFP (>20 ng/ml) who underwent US were analyzed for AFP and AFP-L3 levels after a 10-year frozen storage period.
• Hepatocellular carcinoma (HCC) diagnosis was based on US findings and patient history.

Main Results:

• After 10 years, 148 samples retained AFP levels >20 ng/ml, showing a significant decrease (p < 0.001).
• Of these, 23 cases (15.5%) were diagnosed with HCC at baseline screening.
• AFP-L3 levels showed no significant difference between HCC and non-HCC cases, with an area under the ROC curve of 52% (p=0.757) for HCC prediction.
• Prolonged serum storage may impact analyte quality.

Conclusions:

• AFP-L3 demonstrated limited utility in differentiating HCC from hepatitis in this community screening cohort.
• The findings suggest that AFP-L3 may not be a reliable biomarker for reducing advanced imaging like US in elevated AFP cases.
• Further research is needed to validate biomarkers for HCC screening in diverse populations, considering sample stability.