Biomarker utility for early diagnosis of hepatocellular carcinoma in Egyptians with viral hepatitis C and B

Abstract

BackgroundThere is an urgent need to identify novel biomarkers for hepatocellular-carcinoma (HCC) patients who cannot be diagnosed early as in very small lesions and alpha-fetoprotein (AFP)-negative HCC reported in 40% of HCC cases.ObjectiveTo investigate the diagnostic efficacy of AFP, lens culinaris agglutinin-reactive AFP fraction (AFP-L3), des-γ-carboxy prothrombin (DCP), and glypican-3 (GPC3) either alone or in combination and the diagnostic efficacy of the GALAD score [sex (G) and age (A), AFP-L3 (L), AFP (A), and DCP (D)] for early detection of HCC among Egyptian patients with virus-related liver cirrhosis, either hepatitis C or -B viruses.Patients and methodsThis case–control study was conducted on 90 patients that were divided equally into three groups: liver cirrhosis (GI), HCC less than 3 cm (GII), and HCC 3–5 cm (GIII). Assay of AFP, AFP-L3, DCP, and GPC3 was done by enzyme-linked immunosorbent assay. GALAD score was calculated.ResultsThe diagnostic value of AFP, AFP-L3, DCP, GALAD, and GPC3 markers to detect HCC lesions less than 3 cm was assessed by the area under the receiver-operating characteristic curve, which was 0.74, 0.8, 0.75, 0.71, and 0.8, respectively. Sensitivity and specificity were calculated for AFP (86.2%, 93.1%), AFP-L3 (97.2%, 95.4%), DCP (93.4%, 86.2%), GALAD (87.2%, 96.2%), and GPC3 (83.6%, 91.4%). On different combinations, the area under the curve was 0.5 with 100% sensitivity and specificity.ConclusionSerum biomarkers AFP, AFP-L3, DCP, and GPC3 complement each other and demonstrated the best performance for early HCC detection.