[Value of alpha 1-fetoprotein (AFP) determination with an ultramicro-ELISA immunoassay in chronic liver diseases with special reference to hepatocellular cancer].

Abstract

920 determinations of alpha 1-fetoprotein were performed in 564 patients with mainly hepatological diseases. For AFP determination double antibody sandwich technique with 10 microliter final volume was used. The ultramicro-ELISA-method, which meets all criteria of a screening parameter, is simple and far more economic than RIA or a commercial enzyme immunoassay. The 3s limit was determined to be 23.2 for men and 29.8 ng/ml for women. 24/26 (= 92.0%) hepatocellular carcinomas (HCC) showed elevated serum AFP concentrations. The serum AFP concentrations in the hepatocellular carcinoma showed different constellations of the findings: 1. AFP below 215 ng/ml (= range suspicious of hepatome, according to Poltenauer); 2. AFP moderately exceeds 215 ng/ml; 3. AFP weeks before death excessively increasing from moderately elevated ranges; 4. AFP decreasing prior to death; 5. AFP course fluctuating; 6. AFP within normal range. 231 liver cirrhoses showed elevated values in 28.1%. Active liver cirrhoses had significantly more often AFP concentrations above 30 ng/ml than inactive had (31.9% as opposed to 10.8%). Active liver cirrhoses and cirrhoses with decompensation of the portal vein had significantly more often (34.9% of 83 probands) increased AFP values than inactive, compensated cirrhoses had (11.9% of 42 probands). Various pathomechanisms of the neosynthesis of AFP in HCC, in liver metastases and in benign liver diseases are discussed. Increases in AFP above 500 ng/ml are practically indicative of hepatocellular carcinoma. Low-grade elevations of AFP in benign liver diseases and liver metastases can be categorized by considering other criteria (persistent or transitory AFP?/trend - increase?/serum concentration) including clinical/paraclinical features. The determination of AFP by the above-mentioned method allows to make a better hepatologic diagnosis. It ist suitable for the still improvable early diagnosis of HCC. AFP screening should be employed in risk groups (liver cirrhoses, HBsAg carriers, chronic HV-B patients).