ABSTRACT

       The mainstay for the diagnosis of hepato-cellular carcinoma (HCC) includes serological markers such as alpha-feto protein (AFP) in addition to imaging modalities and histopathological studies. Because of the rise of serum level of AFP is also seen in patients with liver cirrhosis, it diminishes its sensitivity as a tumor marker in patients with cirrhosis. So, in our study, a new serological biomarker, osteopontine (OPN), which is highly expressed in many malignancies, including lung, breast, prostate, gastric and ovarian tumors was determined and evaluated   in HCC patients with previous cirrhosis.

Our study aimed to assess the value of OPN in early detection of HCC at various locations with variable size with and without metastasis in patients with hepatic cirrhosis in comparison with AFP level.

For this purpose, 60 patients with liver cirrhosis of different etiologies, were included, 40 patients of them having HCC and classified into two equal groups; group I, 16 males and 4 females with mean age 53 years, having metastasis, and group II, 17 males and 3 females, with mean age 51 years, without metastasis.

The remaining 20 patients were classified as group III, with cirrhosis only. Ten healthy subjects were taken as a control group. All subjects were subjected to history taking, clinical examination, laboratory investigations, e.g. liver and renal function tests, blood pictures, abdominal C.T., and determination of serum level of AFP and OPN.

Patients with other malignancies, e.g. lung, prostate … ect. were excluded. The mean values of AFP in patients of groups I, II and III were 894±211, 862±186, 28.15±51.19 respectively, and AFP at cut-off value of 15 ng/ml had sensitivity 70% and specificity 100% in group I and 50% and 100% in group II, while the mean values of OPN levels were 99.6±42, 58.2±38.1 and 8.9±3.2 in group, I, II and III respectively. OPN level at cut-off value 9.6 ng/ml had sensitivity 100% and specificity 95% in both groups.

In conclusion, OPN has a superior diagnostic accuracy than AFP in patients with HCC with and without metastasis, and its plasma level did not change significantly with the degree of liver cirrhosis.