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Open Access Research article

Alpha-1-acid glycoprotein as potential biomarker for alpha-fetoprotein-low hepatocellular carcinoma

Indra Bachtiar1*, Valentine Kheng1, Gunawan A Wibowo1, Rino A Gani2, Irsan Hasan2, Andri Sanityoso2, Unggul Budhihusodo2, Syafruddin AR Lelosutan3, Ruswhandi Martamala3, Wenny A Achwan4, Soewignyo Soemoharjo4, Ali Sulaiman5, Laurentius A Lesmana2 and Susan Tai1

Author Affiliations

1 Proteomic Division, Mochtar Riady Institute for Nanotechnology, Lippo Karawaci, Tangerang, 15811, Indonesia

2 Hepatology Division, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia

3 Gastroentero-Hepatology Division, Department of Internal Medicine, Gatot Soebroto Hospital, Jakarta, Indonesia

4 Department of Internal Medicine, Mataram General Hospital, Mataram, Indonesia

5 Department of Hepatology, Klinik Hati "Prof. Ali Sulaiman", Jakarta, Indonesia

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BMC Research Notes 2010, 3:319  doi:10.1186/1756-0500-3-319

Published: 23 November 2010



The outcome of patients with hepatocellular carcinoma (HCC) remains poor because of late diagnosis. We determined the performances of α -1-acid glycoprotein (AAG) and des-γ-carboxy prothrombin (DCP) for the diagnosis of HCC, especially for α-fetoprotein (AFP)-low HCC.


Of the 220 patients included in this retrospective study, 124 had HCC, and 61 (49%) of these were AFP-low HCC (AFP ≤ 20 ng/mL). The remaining 96 patients, including 49 with chronic hepatitis B or C and 47 with cirrhosis, were considered as control. Plasma AAG was analyzed using high performance liquid chromatography (HPLC) and confirmed using Western blot technique.


When all patients with HCC were evaluated, the area under receiver operating characteristic (ROC) curves for AAG (0.94, 95% CI: 0.91-0.97) and DCP (0.92, 95% CI: 0.88-0.95) were similar (P = 0.40). AAG had better area under ROC curve (0.96, 95% CI: 0.94-0.99) than DCP (0.87, 95% CI: 0.81-0.93) for AFP-low HCC (P < 0.05). At the specificity 95%, the sensitivity of AAG was higher in AFP-low HCC than in AFP-high HCC (82% and 62%, respectively). In contrast, higher sensitivity was obtained from DCP in discriminating HCC patients with low AFP than that in high AFP (57% and 90%, respectively).


Our cross-sectional study showed that AAG was better performance in diagnosing HCC patients with low AFP, while DCP did better in those with high AFP.