New and old biomarkers of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is a significant cause of mortality in patients with chronic liver disease around the world. Development of biomarkers for early HCC detection is a primary public health goal to decrease mortality. The ideal biomarkers should be highly sensitive and specific for surveillance of high-risk populations and early detection of HCC and also be able to predict therapeutic outcome and provide a prognosis on survival. Currently, the new biomarkers do not perform better than the conventional ones such as alpha-fetoprotein in such a way that they could be widely adopted in clinical practice. Another problem is the low sensitivity of these biomarkers in the detection of HCC. Further work on the development of novel biomarkers and on a combination of them is necessary. Advances in identifying unique molecular signatures including genomic, proteomic, metabolomic, and glycomic profiles have improved our understanding of many biological processes involved in HCC. This review focuses on the role of old and new biomarkers in surveillance, diagnosis, prognosis, and prediction of response to therapeutic targets for HCC and provides up-to-date data to health-care providers which would be applied in clinical practice.

Liver cancer screening in China: practices and its extended questions

“…AFP has been shown to be a sensitive and specific marker for screening [17,18,[54][55][56][57] . In the early stage of liver cancer, abnormal levels (> 20 μg/L) can be detected in serum, which can ensure that most patients with liver cancer have a long enough DPP characterized with positive AFP even 2 years before the clinical presentation of liver cancer [58] .…”

“…In the early stage of liver cancer, abnormal levels (> 20 μg/L) can be detected in serum, which can ensure that most patients with liver cancer have a long enough DPP characterized with positive AFP even 2 years before the clinical presentation of liver cancer [58] . When an AFP cut-off of 20 μg/L is used, the sensitivity and specificity of AFP for HCC were in the range of 41%-65% and 80%-95%, respectively [56,[59][60][61] ; and the sensitivity and specificity of AFP would be changed if the cut-off value is modified [56,62] . In Qidong's screening program the sensitivity and specificity were 55.3% and 86.5%, respectively [19] .…”

“…So far, AFP remains an effictive screening tool or marker for liver cancer detection, especially in undeveloped countries/areas, on Asia, and even in some areas in developed countries [55][56][57]65,80,86] , because there is no a single "all-in-one" biomarker that fits all-surveillance, diagnosis, or prediction of prognosis [62] . In order to improve the sensitivity and specificity of screening and prevent missed diagnosis, the combination use of US and AFP test are strongly recommended.…”

“…In order to improve the sensitivity and specificity of screening and prevent missed diagnosis, the combination use of US and AFP test are strongly recommended. Since about 30% of liver cancers are negative for serum AFP, novel diagnostic markers need to be established [56] . There are no data to support the use of multidetector CT or dynamic MRI for surveillance [108] , but one report [133] showed that the sensitivity estimates of CT and MRI for liver cancer detection were 0.70 and 0.86, respectively, and the combined use was 0.94.…”

Hepatocellular carcinoma occurred in a Hepatitis B carrier clinic cohort during a mean follow up of 10 years

“…The methods for early detection of HCC mainly rely on alpha-fetoprotein (AFP), AFP-lectin 3 fraction (AFP-L3), des-γ-carboxy prothrombin, and liver ultrasound (US) [5][6][7][8]10,11] . Many new biomarkers are under investigation [12][13][14] , but they appear to be more expensive and were not found to be significantly superior to AFP and US in a large population survey [15] .…”