ABSTRACT
To assess the diagnostic significance of serum AFP-L3,AFP-mRNA and methylated p16 in patients with liver cirrhosis and HCC. The present study was conducted on patients suffering from liver cirrhosis [n=82] and HCC [n=82]. in addition to healthy control group [n=20]. Cirrhotic patients were followed up every 3 months for 15 months and grouped according to Child classification A, B and C HCC patients were grouped according to Okuda classification I. II. Ill. Blood samples were withdrawn and serum samples were separated for estimation of liver function tests, anti HCV. HBsAg. AFP. and AFP-L3. RNA was extracted from whole blood for detection of AlP mRNA. The buffy coat was collected for DNA extraction for detection of methylated p16. Liver function tests were assayed spectrophotometrically while anti-HCV. HBsAg and AFP were assayed by enzyme immunoassay. AFP-L3 was measured by liquid phase binding assay. AFP-mRNA and metholated P16 were measured by RT-PCR. In the present study. anti-HCV was present in 90.2% of cirrhotic group and 93.4% of HCC group while HBsAg was present in 2.4% of cirrhotic group and 3,fl[of HCC group. There were significant increase in AFP. AFP-L3Y and AFP-L3 concentrations in HCC versus controls and cirrhotic groups. ln cirrhotic group 6 cases are AFP-mRNA positive [two cases of Child A and 4 cases of Child C]. On the other hand all cirrhotic groups were negative of methylated p16. in HCC group 10 cases are positive of mRNA [two cases of Okuda 1.6 cases of Okuda II and 2 cases of Okuda Ill] On the other hand 4 cases of Okuda Ill are positive of methylated p16 and had AFF more than 100 ng/ml. Among 51 patients with liver cirrhosis [followed up by periodic examination with ultrasonography and measurement of serum AFP every 3 months 6 patients developed HCC [11.7%]. The sensitivity of AFP-L3 was 64.1% and a specificity 89.2% or a cutoff level of 1.0% . The sensitivity of AFP was 51.8% and the specificity was 88.2% whereas the sensitivity of AFP-L3 concentration was 51.3% and a specificity 100% for a cutoff level of 22.08 ng/ml. The sensitivity of AFP-mRNA and p16 methylation were 41.6% and 16.6% while the specificity were 75% and 100%, respectively. In HCC group there were significant positive correlations between AFP-L3 concentration and AFP, and AFP-L3% . AFP-L3% had higher sensitivity and specificity than AFP. Thus both markers must be done simultaneously. The detection of methylated p16 had the lowest sensitivity and highest specificity. AFPmRNA and methylated p16 in the blood of HCC patients were significantly correlated with elevated AFP