Mossad Nehad A, Mahmoud Enas H, Osman Enas A, Mahmoud Sherif H, Shousha Hend I
Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Tumour Biol. 2014 Nov;35(11):11559-64. doi: 10.1007/s13277-014-2467-y. Epub 2014 Aug 17.
Hepatocellular carcinoma (HCC) surveillance lacks a reliable biomarker. Alpha-fetoprotein (AFP) is the most widely used. However, not all HCCs secrete AFP. AFP may be elevated with cirrhosis in the absence of HCC. Serum alpha-L-fucosidase (AFU) and squamous cell carcinoma antigen-immunoglobulin M complex (SCCA-IgM) were found to be useful markers in diagnosing HCC. SCCA-IgM and AFU were assessed by ELISA technique; AFP was measured by enzyme chemiluminescence in serum of 40 patients with HCC, 30 patients with liver cirrhosis, and 20 healthy control participants to compare their accuracy in early diagnosis of HCC. Serum SCCA-IgM and AFU levels were significantly elevated in HCC group compared to cirrhotic group (P value<0.001 and <0.001, respectively). Receiver operating characteristic curve showed the optimal cutoff value for SCCA-IgM was 233 AU/ml with sensitivity 87.5% and specificity 66% and for AFU was 25 U/L with sensitivity 87.5% and specificity 98%. AFP cutoff value was 48 ng/mL with sensitivity of 70% and specificity of 53.3%. The simultaneous determination of AFP and SCCA-IgM activity increased the sensitivity to 92.5% and specificity to 62.1%. There were positive significant correlations between SCCA-IgM and each of AFU (r=0.296, P=0.005) and AFP (r=0.284, P=0.007) and no correlation between AFP and AFU. All markers did not correlate with the tumor size or affected by the Child score. The significant difference between SCCA-IgM and AFU levels among HCC and cirrhotic patients suggests their use as potential diagnostic tools and allows identifying a new group of HCC patients even in the absence of elevated AFP.
肝细胞癌（HCC）监测缺乏可靠的生物标志物。甲胎蛋白（AFP）是应用最广泛的。然而，并非所有HCC都分泌AFP。在没有HCC的情况下，肝硬化也可能导致AFP升高。血清α-L-岩藻糖苷酶（AFU）和鳞状细胞癌抗原免疫球蛋白M复合物（SCCA-IgM）被发现是诊断HCC的有用标志物。采用酶联免疫吸附测定（ELISA）技术评估SCCA-IgM和AFU；采用酶化学发光法检测40例HCC患者、30例肝硬化患者和20例健康对照者血清中的AFP，以比较它们在HCC早期诊断中的准确性。与肝硬化组相比，HCC组血清SCCA-IgM和AFU水平显著升高（P值分别<0.001和<0.001）。受试者工作特征曲线显示，SCCA-IgM的最佳临界值为233 AU/ml，灵敏度为87.5%，特异性为66%；AFU的最佳临界值为25 U/L，灵敏度为87.5%，特异性为98%。AFP的临界值为48 ng/mL，灵敏度为70%，特异性为53.3%。同时检测AFP和SCCA-IgM活性可使灵敏度提高到92.5%，特异性提高到62.1%。SCCA-IgM与AFU（r=0.296，P=0.005）和AFP（r=0.284，P=0.007）均呈显著正相关，而AFP与AFU之间无相关性。所有标志物均与肿瘤大小无关，也不受Child评分影响。HCC患者和肝硬化患者之间SCCA-IgM和AFU水平的显著差异表明它们可作为潜在的诊断工具，即使在AFP未升高的情况下也能识别出一组新的HCC患者。
