Serum α‐L‐fucosidase activity and early detection of hepatocellular carcinoma

BACKGROUND Serum α-L-fucosidase activity is considered a marker of hepatocellular carcinoma. To the authors' knowledge, its clinical usefulness in the early detection of hepatocellular carcinoma in the follow-up of cirrhotic patients has not been reported previously. METHODS The authors prospectively studied serum α-L-fucosidase activity, in addition to α-fetoprotein and ultrasonography, in a regular screening of 132 cirrhotic patients during an 8-year follow-up. RESULTS At enrollment, 120 patients had low α-L-fucosidase activity (below the cutoff value) and 12 had high activity. All patients had serum α-fetoprotein levels below the cutoff value. During the follow-up, hepatocellular carcinoma was detected in 19 patients, 16 with α-L-fucosidase activity below the cutoff value at enrollment and 3 with activity above it. In 7 of those 16 patients with carcinoma and low enzyme activity, the enzyme activity showed a significant increase 6-9 months before there was ultrasonographic evidence of a focal lesion, and by the time of diagnosis it had risen above the cutoff value in all of them; in only 3 of the 7 patients was the increase in α-L-fucosidase activity associated with an increase in α-fetoprotein. In another 4 of the 19 patients with carcinoma, only α-fetoprotein increased. CONCLUSIONS Serum α-L-fucosidase activity is useful in the early detection of hepatocellular carcinoma. The data from this study suggest that cirrhotic patients who have a marked increase in serum α-L-fucosidase levels during follow-up should be closely monitored for signs of hepatocellular carcinoma development. Cancer 1998;83:2468-2474. © 1998 American Cancer Society.