PMC5465790_01
Clinical course of case 1. After the operation of bone metastasis, his serum AFP level and AFP-L3 frequency returned to the normal range. Fourteen months after the operation, only AFP-L3 started to elevate and then reappearance of bone metastasis was confirmed by PET-CT.
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AFP levels remained at 3 ng/mL. AFP-L3 frequency tended to increase with time, while the AFP level remained within the normal range for several months. Although neither computed tomography (CT) nor MRI showed any abnormalities, positron emission tomography (PET)-CT did reveal hot spots at the first lumbar vertebra (Fig. 1).
PMC5465790_02
Clinical course of case 2. After the operation of huge HCC, his serum AFP level and AFP-L3 frequency returned to the normal range. Seven months post-treatment, the AFP-L3 frequency increased again, while the serum AFP and DCP levels remained within the normal range. Soon after this AFP-L3 elevation, intrahepatic metastasis was confirmed by CT.
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We suspected HCC recurrence based on the elevation of AFP-L3 frequency, which resulted in detection of HCC recurrence by CT at an earlier date than would have occurred without this test (Fig. 2).