The Use of Serum Survivin and AFP-L3 and their Combination in Improving Hepatocellular Carcinoma Diagnosis Especially in Patients with Low Serum AFP

Document Type : Original Article


The Departments of Surgical Pathology, National Cancer Institute, Cairo University* and Hepatology, National Liver Institute, Menoufia University**, Menoufia, Egypt


Background: Hepatocellular carcinoma (HCC) is respon-sible for about 4.7% of chronic liver disease in Egypt. Survivin is an essential element in apoptosis inhibition. Survivin is present in fetal and malignant adult tissue and is absent in non malignant tissues. A diagnostic and prognostic HCC marker is the alpha-fetoprotein (AFP) binding to Lens culinaris agglutinin (AFP-L3%) percentage. There is a need for HCC marker that is better than AFP especially in those low AFP.
Aim of Study: To detect the role of determination of serum Survivin gene, AFP-L3% and their combination in HCC diagnosis.
Subjects and Methods: Fifty HCC patients and 20 healthy control persons were subjected for measurement of serum AFP, survivin gene and AFP-L3%. Reverse transcription-polymerase chain reaction (RT-PCR) was used for detection of serum survivin gene. AFP-L3% was measured by a liquid-phase binding assay on the Wako LiBASys clinical auto analyzer.
Results: Serum Survivin gene was positive in 27 (54%) HCC cases and negative in 23 (46%) cases. AFP-L3% was detected in 36 (72%) HCC cases. The combined use of serum servivin gene and AFP-L3% were positive in 43 (86%) of HCC cases. In 22 HCC cases with serum AFP below 200 ng/ml serum servivin gene was detected in 9 (40.9%) cases but AFP-L3% was positive in 13 (59.9%) cases and the combined use of positive serum servivin and AFP-L3 were present in 18 cases (81.18%).
Conclusions: The combined use of serum survivin gene and AFP-L3% could have a valuable diagnostic role in HCC especially in those with low AFP.