Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, particularly in patients with viral cirrhosis. Alpha-fetoprotein (AFP) is widely used for HCC diagnosis; however, it suffers from limited sensitivity and specificity, especially in early-stage HCC. Alpha-L-fucosidase (AFU) has emerged as a potential biomarker for HCC detection.
Aim of the Work: To evaluate AFU diagnostic performance compared to AFP in Egyptian patients with HCC post-viral cirrhosis.
Patients and Methods: A cross-sectional case-control study was carried out on 90 participants divided into three groups: HCC patients with viral cirrhosis (n=30), cirrhosis-only patients (n=30), and healthy controls (n=30). Serum AFP and AFU levels were measured using ELISA.
Results: AFU levels were considerably higher in HCC patients (129.87±32.99 U/ml) compared to cirrhotic (33.43±14.82 U/ml, P-value <0.001) and healthy controls (3.18±1.20 U/ml, P-value <0.001). AFP levels were also elevated in HCC patients (4431.21±11438.90 ng/ml) versus cirrhotic (883.83±973.62 ng/ml, P-value <0.05) and healthy controls (P-value <0.001). AFU demonstrated 100% sensitivity and 90% specificity at a cutoff >52 U/ml, with an accuracy of 99.4%. AFP showed 96.67% sensitivity and specificity at a cutoff >10.5 ng/ml, with 97.6% accuracy.
Conclusion: AFU is a highly sensitive and complementary biomarker to AFP for HCC diagnosis in cirrhotic patients. Combining AFU and AFP may improve early detection of HCC, particularly in AFP-negative cases.