INVESTIGATING THE ROLE OF NON-INVASIVE BIOMARKERS IN THE EARLY DIAGNOSIS OF HEPATOCELLULAR CARCINOMA, ESPECIALLY IN PATIENTS WITH LIVER CIRRHOSIS

Main Article Content

Muhammad Sohail
Waqar Ahmad
Ahmad Zeb
Muhammad Noman Khalil
Fazleamin
Waleed Asif Khursheed
Muhammad Saad Rasheed
Adnan Khan
Shakir Ali Khan
Ifitikhar Alam

Keywords

hepatocellular carcinoma, liver cirrhosis, biomarkers, early diagnosis.

Abstract

Background: Liver cancer especially hepatocellular carcinoma (HCC) has attributed to high mortality rates worldwide, especially among patients with cirrhosis. Tumour detection is therefore important since it enhances high survival rates. The non-invasive biomarkers represent a very attractive strategy for the early diagnosis of HCC taking in consideration the fact that a large number of patients may benefit from the early diagnosis and actually do not require invasive procedures.


Objectives :To determine the accuracy of non-invasive biomarkers in diagnosis of early stage HCC in patient with liver cirrhosis.


 


Study Design: A Cross-sectional-study


 


Duration and place of study: Department of Medicine, Ayub Teaching Hospital, Abbottabad, KPK, Pakistan from July 2023 to July 2024.


 


Methods : A total of one hundred cirrhotic patients were assessed for the presence of HCC by using noninvasive markers, that is AFP and DCP. The patient demographics liver function tests and imaging findings were recorded at the time of admission into the study. According to the analysis of the results obtained, the sensitivity, specificity and predictive value of the biomarkers were established.


Results : The study included 100 patients with a mean age of 55. 3 years (standard deviation: The average age was 8. 7 years and that is calculated with seventy patients having a record of measuring age between 8 years and 9 years. AFP was 75% sensitive and 80% specific while DCP was 82% sensitive and 85% specific. The increase in diagnostic accuracy was made obvious by use of both AFP and DCP (p-value < 0. 05). Establishing that biomarkers are related to tumor size and stage with an aim of determining thier ability in early diagnosis.


Conclusion : AFP and DCP are relatively non- invasive biomarkers that may be useful in early diagnosis of HCC in patients with cirrhosis. Together the two improve the diagnostic reliability, providing a useful added weapon for clinicians in the war against high risk patients.

Abstract 158 | PDF Downloads 36

References

1. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301-1314.
2. Singal AG, Lampertico P, Nahon P. Epidemiology and surveillance for hepatocellular carcinoma: New trends. J Hepatol. 2020;72(2):250-261.
3. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236.
4. Tzartzeva K, Obi J, Rich NE, et al. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology. 2018;154(6):1706-1718.e1.
5. Omata M, Cheng AL, Kokudo N, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017;11(4):317-370.
6. Khalaf N, Ying J, Mittal S, et al. Natural history of untreated hepatocellular carcinoma in a US cohort and the role of cancer surveillance. Clin Gastroenterol Hepatol. 2017;15(2):273-281.e1.
7. Di Bisceglie AM, Hoofnagle JH. Elevations in serum alpha-fetoprotein levels in patients with chronic hepatitis B. Cancer. 1989;64(10):2117-2120.
8. Shirakawa H, Kuronuma T, Watanabe M, et al. Glypican-3 is a useful tumor marker for early stage hepatocellular carcinoma and associated with poor prognosis. BMC Cancer. 2009;9:72.
9. Bertino G, Neri S, Bruno CM, et al. Diagnostic and prognostic value of alpha-fetoprotein, des-gamma-carboxy prothrombin, and squamous cell carcinoma antigen immunoglobulin M immune complexes in hepatocellular carcinoma. Panminerva Med. 2007;49(3):201-205.
10. Kudo M, Izumi N, Kokudo N, et al. Management of hepatocellular carcinoma in Japan: consensus-based clinical practice guidelines revised 2010. Hepatol Res. 2012;42(10):867-885.
11. Llovet JM, Villanueva A, Lachenmayer A, Finn RS. Advances in targeted therapies for hepatocellular carcinoma in the genomic era. Nat Rev Clin Oncol. 2015;12(8):408-424.
12. He G, Karin M. NF-κB and STAT3 - key players in liver inflammation and cancer. Cell Res. 2011;21(1):159-168.
13. Mazzanti R, Arena U, Tassi R. Hepatocellular carcinoma: where are we? World J Exp Med. 2016;6(1):21-36.
14. Yang JD, Roberts LR. Hepatocellular carcinoma: A global view. Nat Rev Gastroenterol Hepatol. 2010;7(8):448-458.
15. Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology. 2016;150(4):835-853.
16. Marrero JA, Feng Z, Wang Y, et al. Alpha-fetoprotein, Des-gamma carboxyprothrombin, and lectin-bound alpha-fetoprotein in early hepatocellular carcinoma. Gastroenterology. 2009;137(1):110-118.
17. Kudo M, Trevisani F, Abou-Alfa GK, et al. Hepatocellular carcinoma: therapeutic guidelines and medical treatment. Liver Cancer. 2017;6(1):16-26.
18. Sterling RK, Jeffers L, Gordon F, et al. Utility of AFP, DCP, and AFP-L3 in patients with HCV cirrhosis and HCC. Gastroenterology. 2012;143(3):789-798.
19. Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomized phase 3 non-inferiority trial. Lancet. 2018;391(10126):1163-1173.
20. Best J, Bechmann LP, Sowa JP, et al. Role of alpha-fetoprotein and des-gamma-carboxy prothrombin as biomarkers for hepatocellular carcinoma: a systematic review. Liver Int. 2020;40(5):1312-1328.

Most read articles by the same author(s)

1 2 > >>