Abstract
Complications of chronic liver diseases – particularly hepatocellular carcinoma (HCC) – are a major cause of mortality worldwide. Several studies have shown that high or increasing levels of serum Squamous Cell Carcinoma Antigen-Immunoglobulin M complex (SCCA-IgM) are associated with development of HCC in patients with advanced liver disease and worse survival in patients with liver cancer. The aim of the present study was to assess, in patients with advanced liver disease, differences in long-term clinical outcomes in relation to baseline levels of serum SCCA-IgM. Ninety one consecutive outpatients with liver cirrhosis of different etiologies, without hepatocellular carcinoma at presentation, were enrolled from April 2007 to October 2012 in a prospective study. For a median time of 127 months, patients were bi-annually re-evaluated. SCCA-IgM complex levels were determined with a validated enzyme-linked immunosorbent assay. The results provided evidence that serum SCCA-IgM is a predictor of overall survival. The best cut-off to discriminate both HCC-free and overall survival rates was 120 AU/mL. Patients with baseline values higher than this threshold showed a substantial increase in both HCC incidence rate and all-cause mortality rate. In conclusion, a single measurement of serum SCCA-IgM helps to identify those patients with liver cirrhosis with increased risks of HCC development and mortality.
Highlights
Hepatocellular carcinoma (HCC) is a major determinant of cancer-related death worldwide, and the first ranking neoplasm for overall increase in mortality rates in many industrialized and developing countries[1,2]
Previous studies indicate that Squamous Cell Carcinoma Antigen (SCCA) overexpression is an early event in hepatic carcinogenesis[8]
For 20 of these patients (66.7%), the first-line treatment consisted in a loco-regional therapy, being in 10 cases Transcatheter Arterial Chemo-Embolization (TACE), in 9 cases Radio-Frequency Ablation (RFA), in one case Percutaneous Ethanol Injection (PEI) and in one case surgical resection
Summary
Hepatocellular carcinoma (HCC) is a major determinant of cancer-related death worldwide, and the first ranking neoplasm for overall increase in mortality rates in many industrialized and developing countries[1,2]. New screening modalities that include novel serum biomarkers, integrative scores, and imaging techniques for early HCC detection are under development or evaluation[7]. SCCA-1 isoform ( known as Serpin B3) is implied in many biological functions, including resistance to apoptosis, induction of cell proliferation and promotion of epithelial-mesenchymal transition[9]. All these complex features may explain why, as described in several cancers of epithelial origin, liver neoplasms that overexpress SCCA tend to display worse grades of inflammation, anaplasia and invasiveness[10,11,12]
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