Serotonin: is it a marker for the diagnosis of hepatocellular carcinoma in cirrhotic patients?

Abstract

Hepatocellular carcinoma (HCC) is the third most frequent cause of cancer mortality among men worldwide. Serotonin is biogenic amine, ligand for family of 5-HT receptors reflect the diversity of serotonergic actions.Majority of serotonin in body 90% synthesised by enterochromaffin cells of the gastrointestinal tract and exported to various sites. Serotonin regulate blood flow and vascular tone at portal and sinusoidal levels, serotonin mitogen for hepatocytes and promotes liver regeneration. 5HT emerging as mediator of different pathological conditions (double edged sowrd). It contributes to liver fibrosis, mediates oxidative stress in nonalcoholic steatotic hepatitis and aggravates viral hepatitis, these conditions involved in tumorgenesis of hepatocellular carcinoma (HCC). Impaired metabolic function in liver cirrhosis and slow uptake and storage of serotonin by the platelets is sequelae of kinetic change of serotonin transport mechanisms or abnormal serotonin release from dense granules of activated platelets condition defined “platelet exhaustion”, contributes to elevated plasma serotonin which may facilitate tumor growth of primary liver hepatocellular carcinoma. Aim of this work: was to determine whether serotonin is a marker for the diagnosis of hepatocellular carcinoma in cirrhotic patients. Methods: patients were classified into 2 groups; 45 patients with cirrhosis only and 30 patients with cirrhosis and HCC. 10 healthy subjects was taken as controls. Patients underwent; full history taking,clinical examination,abdominal ultrasonography. Laboratory methods include SGOT, SGPT, GGT, bilirubin, alkaline phosphatase, total proteins, albumin, CBC, prothrombin, INR, APRI score, Child-Pugh score, MELD score, AFP and serum serotonin. Results: plasma serotonin was significantly higher in patients group with cirrhosis with a median level 119.4 ng/ml than in control group showed median value of 51.5 ng/ml p< 0.001.Also a significance difference between cirrhosis &HCC group with median value 478.35 ng/ml than control group and cirrhosis group p<0.001was found. Conclusion: Plasma serotonin level was significantly higher in patients with cirrhosis and HCC than in those with cirrhosis only and it was involved in tumorgenesis of hepatocellular carcinoma.