Evaluation of leucocyte adherence inhibition in hepatocellular carcinoma.

The value of the leucocyte adherence inhibition (LAI) test in the diagnosis of hepatocellular carcinoma (HCG) was investigated in 36 patients with this tumour. The sensitivity and specificity of the tube LAI test was assessed in 21 patients with HCC, 15 apparently healthy individuals, 9 patients with various forms of benign liver disease and 5 patients with non-hepatic neoplasms. In only 42% of the HCC patients tested was leucocyte adherence to glass reduced to a greater extent than in the healthy controls and in the patients with non-hepatic neoplasms, and the differences were not statistically significant. Moreover, positive results were obtained in 6/9 patients with benign hepatic disease. A further 15 patients were tested against extracts of HCC tissue using the haemacytometer LAI method. Of these, 53% gave positive results. In all, only 17/36 patients (47%) gave positive LAI responses. The test is thus of limited value in the diagnosis of HCC. The high false-negative result rate may be due either to abrogation of the immune response in HCC patients with large tumour burdens or to antigenic heterogeneity in HCC

Carcinoembryonic antigen in hepatocellular cancer.

Serum carcinoembryonic antigen (CEA) concentrations were found to be raised in 28 of 72 black patients (39%) with hepatocellular cancer (HCC). The degree of elevation was slight or moderate, except in 3 patients in whom values greater than 20 ng/ml were recorded. No significant correlation could be demonstrated in individual patients between the serum CEA concentration and various tests of liver function. The mean CEA value in the patients with cirrhosis in the non-tumorous liver was slightly higher than that in those without cirrhosis, but the difference did not reach statistical significance. There was no correlation between serum CEA and alpha-foetoprotein (AFP) levels

Tumour-associated isoenzymes of gamma-glutamyl transferase in the serum of patients with hepatocellular carcinoma.

Sera from 391 southern African Blacks with hepatocellular carcinoma, matched controls, patients with other malignant tumours, and with various forms of hepatobiliary disease were fractionated by polyacrylamide gradient gel electrophoresis to determine the prevalence of tumour-associated gamma-glutamyl transferase isoenzymes in Black patients with hepatocellular carcinoma. One or more tumour-associated isoenzymes (I', I'' or II') were present in 58.6% of the patients with hepatocellular carcinoma: I' in 54.5%, I'' in 27.1%, and II' in 34%. These isoenzymes were detected in one patient with prostatic cancer, occasionally in patients with acute viral hepatitis, but in no normal individuals. The presence of tumour-associated isoenzymes was not related to patient age, sex or hepatitis-B virus status or to the tumour burden. Isoenzymes were present in 42 percent of hepatocellular carcinoma patients with a normal serum alpha-foetoprotein concentration and in 50% of those with a non-diagnostic value. gamma-glutamyl transferase isoenzymes may be supplementary to alpha-foetoprotein in the diagnosis of hepatocellular carcinoma

Serum immunoglobulin levels in primary liver cancer: relationship to underlying cirrhosis and hepatitis-B (surface) antigenaemia.

Serum IgG, IgM and IgA levels were measured by the single radial diffusion method in 107 South African Negro patients with primary hepatocellular cancer (PHC) and 112 healthy Negro blood donors. The mean serum IgG ANd IgM concentrations were significantly higher (P less than 0-001) in the PHC patients. In those patients in whom PHC was associated with cirrhosis, the serum IgG level was greater (P less than 0-02) than in those without cirrhosis. However, the mean serum IgG concentration in the non-cirrhotic cancer patients was still significantly higher than the control value (P less than 0-001). Thus, while cirrhosis may contribute to the raised IgG levels in PHC, other factors must also be involved. There was no difference in the serum immunoglobulin concentrations in PHC patients with and without hepatitis-B antigenaemia

Hepatitis-B surface antigen and antibody in Bantu patients with primary hepatocellular cancer.

Hepatitis-B surface antigen (HBsAg) was found in the serum of 58 of 158 (36-4%) southern African Bantu patients with primary hepatocellular cancer by counter immunoelectrophoresis and in 94 (59-5%) by radioimmunoassay (RIA). The prevalence of this antigen in the general Bantu population using these methods was 7% and 9% respectively. Antibody against HBsAg was detected in 11-6% of the patients by passive haemagglutination (PH) and 13-4% by RIA, and in 33-4% (by PH) of a control population. Antibody sub-types were predominantly "adw" (69-2%) with a lesser frequency of "ayw" (23%), while 7-8% were indeterminate. The corresponding figures in the controls were 80-4, 8-4 and 11-2%. HBsAg was more common in younger patients. No relationship could be demonstrated between hepatitis-B antigenaemia and the presence of alpha-foetoprotein in high concentration, although there were far fewer patients in the alpha-foetoprotein-negative group

Alpha-L-fucosidase as a serum marker of hepatocellular carcinoma in southern African blacks.

The purpose of this study was to compare alpha-L-fucosidase and alpha-fetoprotein as serum markers of hepatocellular carcinoma in 72 southern African blacks with this tumour and 64 matched patients with benign hepatic diseases which might be mistaken clinically for hepatocellular carcinoma. Alpha-L-fucosidase activity was assayed using p-nitrophenyl-L-fucopyranoside (pNpf) as a substrate and alpha-fetoprotein concentrations were measured by radioimmunoassay. Serum alpha-L-fucosidase activity in the patients with hepatocellular carcinoma (mean 1,268, s.e.m. +/- 83.7, median 1,150 and range 38-3,698 nmol pNpf ml-1 h-1) was significantly higher than that in the matched controls (mean 798, s.e.m. +/- 65.8, median 648 and range 273-3,825 nmol pNpf ml-1 h-1) (P = 0.0001). However, alpha-L-fucosidase was both less sensitive (75 versus 87%) and less specific (70 versus 87%) than alpha-fetoprotein as a serum marker of hepatocellular carcinoma. When, in an endeavour to eliminate false-positive results, the diagnostic cut-off level for alpha-L-fucosidase was increased to 1,500 nmol pNpf ml-1 h-1 and for alpha-fetoprotein to 400 ng ml-1, the sensitivity of alpha-L-fucosidase fell to 21% whereas that of alpha-fetoprotein remained satisfactory at 78%. If the two markers were used together, the number of false-negative alpha-fetoprotein results was reduced from 13 to 5.5%. We conclude that alpha-L-fucosidase is less useful than alpha-fetoprotein as a single marker of hepatocellular carcinoma in southern African blacks. However, the two markers can profitably be used together