Background: The role of the metabolic syndrome in hepatocellular carcinoma (HCC) has been extensively reported, however, the role of other individual metabolic variables in development of HCC in HCV infected patients is still not clear. This study aimed to investigate the possible role of Parathyroid hormone (PTH), calcium, phosphorus, vitamin D3 and Zinc, serum levels as non-traditional metabolic risk factors in development of HCV-related HCC. Methods: Serum levels of vitamin D3, Zinc, PTH, calcium, and phosphorus were determined in HCV infected patients with and without HCC. Results: Our results show significantly higher age, male sex, aspartate transaminase (AST), PTH and corrected serum calcium levels in the HCC patients compared to values in the other two groups, (p<0.001); while significant lower vitamin D3 and zinc levels were detected among the HCC patients compared to patients with non-HCC liver cirrhosis and CHC, (p<0.001). Vitamin D3 deficiency was detected in 96% of the HCC patients, while it was detected in only 22.5% of the cirrhotic patients and in none of the CHC patients, (p<0.001). However, on multiple stepwise regression analysis, only the age, AST, PTH, and corrected calcium levels were the independent predictors for HCC when studied in relation to chronic liver disease. Conclusions: This study indicates the prevalent high PTH and calcium levels along with deficient vitamin D3 and zinc levels in HCV-induced HCC patients. However, a causal relationship between the low levels of Vitamin D3 and Zinc in relation to HCC development is not established in this study.

Background:The role displayed by parathyroid hormone (PTH) in HCV-related hepatocellular carcinoma (HCC) is not clearly defined. Aim: To investigate serum levels of parathyroid hormone, ionized Calcium (Ca) and corrected calcium in HCV-induced cirrhosis with HCC and to assess if their levels have relation to the child score and MELD score of HCC. Patients and methods: This study recruited patients with HCV-related HCC and HCV infected patients without HCC. A group of healthy subjects was also studied as controls. Liver and renal biochemical profiles, complete blood count and INR were determined. The serum levels of intact PTH (iPTH), ionized calcium and corrected calcium were measured in the three groups. Results: This cross-sectional observational study included fifty cirrhotic patients with HCV-related HCC, 70 HCV infected chronic liver disease patients without HCC and 30 healthy controls. iPTH serum level was significantly higher in the HCC patients compared to the other HCV infected chronic liver disease patients and to the healthy controls, (p<0.001). In addition, ionized calcium and corrected calcium serum levels were significantly raised in HCC than in HCV infected chronic liver disease patients without HCC, (p<0.001). There was no significant difference in iPTH levels between child B and child C HCC patients. Multiple regression analysis indicated the both iPTH and ionized calcium levels were independent predictors for HCC in HCV infected patients, (OR for PTH was 1.01; 95%CI: 1.004-1.02 with p= 0.002. and OR for corrected calcium was 3.18; 95%CI: 1.96-5.14 with p= <0.001). Conclusion: This study indicated the prevalent high levels of iPTH in HCC and associated hypercalcemia and this was not related to liver function. iPTH can be considered as a predictor for HCC occurrence in HCV infected chronic liver disease patients.