Research Paper Volume 14, Issue 6 pp 2645—2664

Clinical utility of serum fucosylated fraction of alpha-fetoprotein in the diagnostic of hepatocellular carcinoma: a comprehensive analysis with large sample size

Aibin Liu1, , Yanyan Li2, , Lin Shen3, , Liangfang Shen3, , Zhanzhan Li3,4, ,

  • 1 Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, PR China
  • 2 Department of Nursing, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, PR China
  • 3 Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, PR China
  • 4 National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, PR China

Received: January 15, 2022       Accepted: March 15, 2022       Published: March 20, 2022
How to Cite

Copyright: © 2022 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


We conducted a comprehensive meta-analysis of the utility of AFP-L3 for the diagnosis of hepatocellular carcinoma, to provide a more accurate estimation for the clinical utility of AFP-L3. We performed online searches in five databases (PubMed, China National Knowledge Infrastructure, Wanfang, Web of Science, and Embase), from inception to December 31, 2021. Pooled sensitivity, specificity, and area under the curve (AUC) with the matching 95% confidence intervals (95% CIs) were calculated to estimate the diagnostic value of AFP-L3. Thirty-four studies were included in the meta-analysis. The pooled sensitivity was 0.70 [95% confidence interval (CI): 0.63–0.77], and the specificity was 0.91 (95% CI: 0.88–0.94). The estimated area under the curve (AUC) was 0.90 (95% CI: 0.87–0.92). The positive likelihood ratio and negative likelihood ratio were 7.78 (95% CI: 5.7–10.7) and 0.33 (95% CI: 0.26–0.41), respectively. The diagnostic odds ratio was 24 (95% CI: 16–37). The subgroup analysis indicated moderate sensitivity (0.79) and high specificity (0.89) for the Asian population (AUC = 0.89), and similar specificity (0.95) but lower sensitivity (0.35) for Caucasians (AUC = 0.80). Deeks’ funnel plot asymmetry test detected no publication bias (P = 0.460). The sensitivity analysis showed that the pooled results were stable. Taken together, our results indicated that AFP-L3 demonstrates high diagnostic ability for HCC, especially among Asian populations. AFP-L3 is a useful means for high-volume screening, which can help doctors optimize diagnosis workflow, reduce workload, and improve detection sensitivity. The combination of multiple biomarkers may provide more accurate diagnostic tools for HCC in the future.


HCC: hepatocellular carcinoma; AFP: Alpha-fetoprotein; AFP-L3: fucosylated fraction of alpha-fetoprotein; DCP: digamma-carboxyl prothrombin; CNKI: China national knowledge internet; CT: computed tomography; PHC: primary hepatocellular carcinoma; ELISA: enzyme-linked immunosorbent assay; ECLIA: electro-chemiluminescence immunoassay; TP: True positive; TN: True negative; FP: False positive; FN: False negative; FP: False positive; TN: True negative; AUC: area under the curve; PLR: positive likelihood ratio; NLR: Negative likelihood ratio; DOR: Diagnostic odds ratio; CI: confidence interval; GP73: Golgi protein 73; AFU: alpha-1-fucosidase CA19-9: carcinoembryonic antigen19-9; HCV: Hepatitis C virus; HBV: Hepatitis B virus.