***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The fucosylated fraction of alpha-fetoprotein ( AFP-L3 ) has been used as a diagnostic marker for hepatocellular carcinoma ( HCC ) . Recently , a highly sensitive immunoassay using an on-chip electrokinetic reaction and separation by affinity electrophoresis ( micro-total analysis system ; μTAS ) has been developed . Aim The aim of this study was to investigate the relationship between changes in the serum AFP-L3 level measured by μTAS assay and recurrence of HCC after curative treatment . Methods A total of 414 HCC patients who met the Milan criteria and underwent hepatectomy or radiofrequency ablation  were investigated prospect ively for the relationship between HCC recurrence and values of tumor markers . Results There were significant differences in recurrence-free survival between groups with and without AFP-L3 elevation measured before and after treatment ( p = 0.024 and p = 0.001 for before and after treatment , respectively ) . Multivariate analysis revealed that AFP-L3 status ( p = 0.002 ) measured 1 month after treatment was a significant independent predictor of HCC recurrence after curative treatment . Conclusions Elevation of the serum AFP-L3 level before treatment is a predictor of HCC recurrence , and sustained elevation of the AFP-L3 level after treatment is an indicator of HCC recurrence . Repeated measurement of μTAS AFP-L3 should be performed for surveillance of HCC recurrence after curative treatment Background sWe previously reported a highly sensitive method for serum human telomerase reverse transcriptase ( hTERT ) mRNA for hepatocellular carcinoma ( HCC ) . α-fetoprotein ( AFP ) and des-γ-carboxy prothrombin ( DCP ) are good markers for HCC . In this study , we verified the significance of hTERTmRNA in a large scale multi-centered trial , collating quantified values with clinical course . Methods In 638 subjects including 303 patients with HCC , 89 with chronic hepatitis ( CH ) , 45 with liver cirrhosis ( LC ) and 201 healthy individuals , we quantified serum hTERTmRNA using the real-time RT-PCR . We examined its sensitivity and specificity in HCC diagnosis , clinical significance , ROC curve analysis in comparison with other tumor markers , and its correlations with the clinical parameters using Pearson relative test and multivariate analyses . Furthermore , we performed a prospect i ve and comparative study to observe the change of biomarkers , including hTERTmRNA in HCC patients receiving anti-cancer therapies .  Results hTERTmRNA was demonstrated to be independently correlated with clinical parameters ; tumor size and tumor differentiation ( P < 0.001 , each ) . The sensitivity/specificity of hTERTmRNA in HCC diagnosis showed 90.2%/85.4 % for hTERT . hTERTmRNA proved to be superior to AFP , AFP-L3 , and DCP in the diagnosis and underwent an indisputable change in response to therapy . The detection rate of small HCC by hTERTmRNA was superior to the other markers . Conclusions hTERTmRNA is superior to conventional tumor markers in the diagnosis and recurrence of HCC at an early stage BACKGROUND AND AIMS : Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein ( AFP-L3 % ) has been reported to be useful in the early detection of hepatocellular carcinoma ( HCC ) in Japan . The aim of this prospect i ve study was to compare the clinical utility of AFP-L3 % with that of total AFP in North American patients . METHODS : Patients with chronic hepatitis ( CH ) C virus-related cirrhosis from 7 clinical sites were prospect ively followed every 3–6 months for 2 yr . RESULTS : Of the 372 patients evaluated , 40 had hepatitis C virus-related HCC at entry and 332 entered the prospect i ve trial . Of the latter , 34 developed HCC and 298 remained free of HCC . The sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) for AFP were 60.8 % , 71.1 % , 34.4 % , and 88.0 % with a cutoff of 20 ng/mL and 21.6 % , 98.7 % , 80.0 % , and 83.5 % with a cutoff of 200 ng/mL , compared to 36.5 % , 91.6 % , 51.9 % , and 85.3 % for AFP-L3 % with a cutoff of 10 % . In those with an elevated AFP ( 20–200 ng/mL ) , AFP-L3 % had a specificity of 86.6 % and an NPV of 80.7 % . Multivariate analysis identified AFP , AFP-L3 % , and age as independent predictors of HCC . Elevated AFP-L3 % was associated with a lower cumulative HCC-free rate at 2 yr ( 58.9 % ) than was AFP ( 82.0 % , P = 0.01 ) . CONCLUSIONS : The incidence of HCC was significantly higher in patients with elevated AFP-L3 %  than in those with elevated AFP . The high specificity of AFP-L3 % persisted among patients with elevated AFP ( 20–200 ng/mL ) and suggests that AFP-L3 % has clinical utility in HCV patients with AFP of 20–200 BACKGROUND AND AIM The Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein ( AFP-L3 ) has been reported to be a highly useful marker for hepatocellular carcinoma ( HCC ) compared with a conventional serum AFP concentration , which allows earlier detection of HCC compared with using other imaging modalities and predicting prognosis after therapy . A collaborative prospect i ve study involving nine Japanese hospitals was conducted to analyze the relationships between the tumor characteristics of a HCC patient and the percentage of AFP-L3/AFP total at the initial detection . METHODS Between 1 October 1996 and 30 September 1997 , a total of 388 patients with newly diagnosed HCC were registered . RESULTS The cut-off level of the percentage of AFP-L3 was altered from 15 to 10 % . The AFP-L3-positive HCC patients demonstrated the characteristics of having an advanced tumor , such as the number of tumors , maximum diameter , tumor spread , portal vein invasion , tumor stage , and tumor classification . With the conventional cut-off level of 15 % of the percentage of AFP-L3 , the malignant characteristics were more definite than that of 10 % . However , no significant differences of serum AFP concentration were observed for malignant characteristics such as maximum diameter and histopathological grading . CONCLUSION Serum AFP concentration does not reveal a malignancy of HCC , however , the AFP-L3-positive HCC has biologically malignant characteristics , especially portal vein invasion and lower tumor classification , and is an advanced tumor regardless of small tumor size and lower serum AFP concentration . As AFP-L3 shows the tumor characteristics , its presence should be an important factor in the determination of therapy and prognosis of patients BACKGROUND AND OBJECTIVE There is no established clinical role for the lens culinaris agglutinin-reactive fraction of alpha-fetoprotein ( AFP-L3 % ) in the management of the Thai hepatocellular carcinoma ( HCC ) patient population . The aim of this prospect i ve study was to evaluate clinical utility and performance characteristics of AFP-L3 % for the diagnosis of HCC in Thai referral patients . MATERIAL AND METHOD Sixty-one histologically proven HCC patients and 35 patients with other liver cancers were included for analysis . RESULTS The HCC population was comprised of 50 males and 11 females , with a mean age of 48.8 years . According to the Okuda system , three were classed as stage I , thirty-five belonged to stages II , and six were classified in stage III . An AFP-L3 % a cut-off value of > 15 % yielded a sensitivity of 82 % ( 95 % confidence interval [ CI ] , 74 - 88 % ) , specificity of 71 % ( 95 % CI , 58 - 82 % ) , positive predictive value of 83 % ( 95 % CI , 75 - 90 ) , and negative predictive value of 69 % ( 95 % CI , 56 - 80 ) for the diagnosis of HCC . In HCC patients with AFP of < 200 ng/ml , an AFP-L3 % at a cut-off value of > 15 % not only maintained high sensitivity of 83 % and good specificity of 71 % but also increased negative predictive value to 86 % for the diagnosis of HCC . CONCLUSION AFP-L3 % provides high sensitivity but with lower sensitivity in the diagnosis of HCC than total AFP in individuals with symptomatic liver mass . However , considering its high negative predictive value in patients with AFP < 200 ng/ml , AFP-L3 % might be useful as an adjunctive marker , in combination with AFP , to exclude the presence of HCC There is no established clinical role for the lens culinaris agglutinin-reactive fraction of alpha-fetoprotein ( AFP-L3 % ) and des-gamma-carboxy prothrombin ( DCP ) in the management of the U.S. hepatocellular carcinoma ( HCC ) patient population . In order to clarify the clinical usefulness and characteristics of AFP-L3 % and DCP , a prospect i ve study was performed on United States patients having histologically proven hepatocellular carcinoma . Ninety-nine histologically proven HCC patients , who were diagnosed with unresectable cancer between July 1999 and March 2001 at the Liver Cancer Center of the University of Pittsburgh Medical Center , were included for analysis . The sensitivity of AFP-L3 % , DCP , and AFP was 61.6 % , 72.7 % , and 67.7 % , respectively . The highest sensitivity , 85.9 % , was obtained in the combination of three markers . Statistically significant differences were observed for portal vein invasion in AFP-L3 % and AFP levels ( P = 0.0059 and P = 0.0360 , respectively ) . DCP was significantly associated with metastasis ( P = 0.0368 ) . There were significant associations between AFP-L3 % and AFP results and patient survival ( P = 0.0150 and P = 0.0020 , respectively ) . AFP-L3 % , platelet count , and albumin showed a significant difference with respect to outcomes on Cox 's proportional hazard model ( P = 0.0059 , P = 0.0073 , and P = 0.0265 , respectively ) . The combination of AFP-L3 % , DCP , and AFP was determined to be superior for detection of HCC compared with each marker alone or to other combinations . AFP-L3 % was significantly related to portal vein invasion and patient outcomes and appears to be a useful prognostic marker for HCC Goals We investigated whether measurement of serum levels of the microRNAs ( miRNAs ) miR-16 , miR-195 , and miR-199a , alone or in combination with conventional serum markers , can help to differentiate hepatocellular carcinoma ( HCC ) from chronic liver diseases ( CLDs ) . Background Recent reports suggest a link between aberrant expression of miRNA , and HCC . Study This retrospective analysis was conducted using sera from 105 HCC patients , 107 CLD patients , and 71 normal control subjects . The miRNAs were measured using real-time reverse transcription-polymerase chain reaction . The conventional HCC markers & agr;-fetoprotein ( AFP ) , lens culinaris agglutinin-reactive AFP ( AFP-L3 % ) , and des-&ggr;-carboxyprothrombin ( DCP ) were measured with commercial kits . Results Serum levels of miR-16 and miR-199a were significantly lower in HCC than in CLD patients or control subjects ( P<0.01 ) . As a single marker , miR-16 had the highest sensitivity for HCC , followed by miR-199a , AFP , DCP , AFP-L3 % , and miR-195 . The combination of miR-16 , AFP , AFP-L3 % , and DCP yielded the optimal combination of sensitivity ( 92.4 % ) and specificity ( 78.5 % ) for HCC , overall and when analysis was restricted to patients with tumors size smaller than 3 cm . As a second-line HCC marker , miR-16 yielded positive HCC predictions in 18 of the 26 ( 69.2 % ) HCC patients with negative results on all 3 conventional markers , most of whom had tumors size smaller than 3 cm ; miR-16 was falsely positive in only 12 of 96 ( 12.5 % ) CLD patients . Conclusions The addition of miR-16 to conventional serum markers improved sensitivity and specificity for HCC . Use of miR-16 for second-line testing in cases considered negative on the basis of conventional HCC markers should be explored in larger , prospect i ve studies BACKGROUND & AIMS Des-gamma-carboxy prothrombin ( DCP ) and Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein ( AFP-L3 ) are surveillance markers used to detect hepatocellular carcinoma ( HCC ) in Japan . This study evaluated their utility , alone or in combination , in a North 
    Output:
    
AFP-L3 % could be complementary to AFP as a marker for HCC