Serum alpha-l-fucosidase enzyme activity as a marker for hepatocellular carcinoma : comparison with afp using roc analysis

Abstract EN

Background : hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms.

It is associated closely with cirrhosis and its prognosis is very poor because the diagnosis is generally late, when the disease is so advanced that any effective treatment is precluded.

Therefore, early detection is important in the management of this type of cancer.

Alpha-L-fucosidase enzyme has been recommended as a marker for HCC at an early stage in many countries all over the world.

Purpose : to evaluate Alpha-L-fucosidase activity level as an early detection of HCC.

Materials and Methods : Alpha-L-fucosidase enzyme.

Levels were measured in 140 cases of chronic liver diseases including 50 patients with liver cirrhosis, 40 patients with chronic hepatitis and 50 patients with hepatocellular carcinoma (HCC).

Results : Alpha-L-fucosidase enzyme levels were significantly higher in patients with HCC than those with chronic hepatitis (p < 0.01) and cirrhosis (p < 0.001), no significant difference was found between patients with cirrhosis or with chronic hepatitis and controls.

In patients with hepatocellular carcinoma, α-L-fucosidase enzyme activity was correlated to the size of the tumor and the histo-pathologic grades but not to the Child Pugh grades and most of the liver function tests.

Using the receiver operative characteristic (ROC) and the differential positive rate (DPR) curves, 10 µmol / L / min was the optimal cut-off value that differentiate patients with HCC from those with cirrhosis.

At this level, the sensitivity, the specificity, and the diagnostic accuracy were 70 %, 86 %, and 73 %, respectively.

AFP was found to be significantly higher in patients with HCC than those with chronic hepatitis and cirrhosis.

The best cut-off value of AFP was 100 ng / ml, at which the sensitivity, specificity, and diagnostic accuracy were 52 %, 96 %, and 74 %, respectively.

The simultaneous determination of AFP and α-L-fucosidase enzyme raised the sensitivity of the test to 80 % with specificity of 100 % and diagnostic accuracy of 90 %.

The area under the ROC curve for AFP and α-L-fucosidase enzyme were 0.764 and 0.846, respectively, the difference is insignificant.

Conclusion : both AFP and α-L-fucosidase enzyme are good markers for HCC and their simultaneous determination may improve the detection of HCC in cirrhotic patients negative for AFP.