Serum level of cytokeratin 19 as a diagnostic and prognostic marker in patients with HCV-related hepatocellular carcinoma

Abstract

Background The heterogeneous nature of human hepatocellular carcinoma (HCC) impedes both treatment strategies and prognostic predictions. Several markers have been proposed for the diagnosis of HCC. Cytoskeleton-associated proteins have been known as cellular integrators in neoplasm formation. Hepatic progenitor cells are thought to express alpha-fetoprotein (AFP) and hematopoietic as well as biliary markers such as cytokeratin 19 (CK 19) and cytokeratin 7. The aim of this study was to verify the role of serum CK 19 alone or in combination with AFP as a diagnostic marker of HCC and to assess the changes in its levels after ablation of HCV-related HCC to evaluate its role as a predictor marker for recurrence of HCC after ablation. The study was conducted on 102 HCV-related cirrhotic patients categorized into three different groups according to the clinical, laboratory, and radiological evaluation: group I—62 patients with early or intermediate HCC who underwent locoregional intervention, group II—20 patients with advanced HCC not fit for any intervention apart from best supportive treatment, and group III—20 cirrhotic patients with no evidence of HCC as proved by two imaging techniques. Results The mean serum levels of CK 19 were 6.5 ± 5.7, 10.5 ± 12.5, and 6.8 ± 2.8 ng/ml in groups I, II, and III, respectively, with no significant difference between groups. Sensitivity, specificity, positive, and negative predictive values of combined AFP and human CK 19 at cutoff levels of 25.5 ng/ml and 6.25 ng/ml were 93.9%, 45%, 87.5%, and 64.3%, respectively. In group I patients, CK 19 levels were comparable in patients with ablated focal lesion and those who did not at baseline; then, it was significantly higher in ablated patients than in patients with residual tumor 1 and 6 months after the intervention. Conclusions Combination of both AFP and CK 19 levels could increase the diagnostic accuracy of suspected HCCs. CK 19 levels are good predictors of ablation/recurrence in patients who underwent interventional procedures minimizing the need for follow-up imaging modalities.

Influence of Cytokeratin-19 Level on Pattern of Hepatocellular Carcinoma in Patients with Liver Cirrhosis

“…CK-19 is an HCC-cancer stem cell marker that plays an integral role in carcinogenesis, metastases, and recurrence (16) . In El Raziky et al (13) study although there was no significant difference in baseline serum CK-19 levels among the three groups, its combination with AFP improved their sensitivity to 93.9% that came in harmony with our results.…”

“…Similarly El Raziky et al (13) , found that there was no significant difference between all groups before any intervention regarding the CK-19 levels.…”

“…El Raziky et al (13) showed that CK19 level was of sensitivity 63.4% and specificity 55% in studied patients (early HCC, advanced HCC or cirrhosis).…”

“…El Raziky et al (13) performed abdominal ultrasonography showing that ascites, was present in 50%, of the advanced HCC group but not present in other groups (cirrhotic patients with early HCC or cirrhotic with no evidence of HCC)…”

“…Moreover, El Raziky et al (13) performed a study to verify the effect of combination of both AFP and CK-19 levels on increase the diagnostic accuracy of suspected HCCs, it show that CK-19 levels are good predictors of ablation/recurrence in patients who underwent interventional procedures minimizing the need for follow-up imaging modalities.…”