Diagnostic and Predictive Value of Some Tumor Markers in the Diagnosis and Follow Up of Patients with Hepatocellular Carcinoma

Early detection of hepatocellular carcinoma (HCC) is essential for successful
treatment. Although the role of alpha fetoprotein (AFP) in the diagnosis of advanced
HCC is well recognized, at least one third of small HCCs and 15–20% of advanced
HCC will be missed unless another diagnostic tool is used. Thus, new serologic
markers with sufficient sensitivity and specificity are required. In the present study,
we aimed at evaluating the diagnostic and prognostic role of AFP, protein induced by
vitamin K absence or antagonist(P1VKA-II), vascular endothelial growth factor
(VEGF), sialic acid, alpha-L-fucosidase (AFU) and transforming growth factor-beta
1 (TGF-β1) in the diagnosis and follow up of Egyptian patients with hepatocellular
carcinoma in an attempt to find a tumor marker with a reasonable sensitivity and
specificity for diagnosis of HCC and monitoring patients after therapy. The study was
conducted on 4 selected groups of patients and a control group. Group I included 10
patients with liver cirrhosis. Group II consisted of 10 patients with benign hepatic
focal lesions. Group III included 10 HCC patients without distant metastasis and
group IV included 10 HCC patients presenting with metastasis. Ten apparently
healthy age and sex matched subjects were also included and served as control
group. AFP, sialic acid, alpha-L-fucosidase (AFU), VEGF, PIVKA-II and TGF- β1
were determined in the blood of five studied groups. The sensitivity and specificity of
the tumor markers were calculated and compared. Significant differences in the
median blood levels of AFP, PIVKA-II, VEGF, sialic acid, TGF- β1 and alpha-L-fucosidase activity (AFU) were found on comparing the HCC groups (with and
without metastasis) with the other groups. The median blood levels of PIVKA- II, α-fetoprotein level, sialic acid and AFU activity were lower in the HCC group without
metastasis compared to that with metastasis (p<0.001). On the other hand, the
median serum VEGF level was higher in the HCC group without metastasis
compared to that of the HCC group with distant metastasis(p<0.001). Serum TGF- β1
level did not vary significantly between both groups (with and without metastasis)
(p>0.05). There were significant lower median blood levels of all parameters in HCC
patients without metastasis after ablation therapy compared to pretreatment levels.
Combined determination of serological markers could be used as a highly valuable
tool for screening and diagnosis of HCC as combination of these markers improved
their sensitivity and specificity. They could also be used as prognostic markers
decreasing the need for more invasive procedures.