Squamous Cell Carcinoma Antigen as a Tumor Marker in Patients with Hepatocellular Carcinoma
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- Category: Vol. 77, June 2009
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Squamous Cell Carcinoma Antigen as a Tumor Marker in Patients with Hepatocellular Carcinoma, NABIL EL-KADY, MOHAMAD S. ABDEL BARY, SHERIF HAMDY, MOHAMAD YOUSEF, AHMAD SALAMA, AZZA ELKHAWAGA, MARIAN F. MORGAN and DINA HELMY
Abstract
Background: Hepatocellular carcinoma (HCC) is consid-ered the fifth most common cancer in the world. Owing to its increased incidence in the last decade and the expected further increase in the next 2 decades, HCC is arousing great interest. HCC commonly develops on cirrhotic livers and therefore, surveillance programs have been suggested to identify early HCC, at a stage suitable for surgical or interventional therapy and has a better clinical outcome. The only serologic marker used in clinical practice is a-fetoprotein (a-FP), but its sensitivity is poor. Hence, the investigation of new markers is required.
Aim of the Study: To assess the clinical utility of squamous cell carcinoma antigen (SCCA) as a non invasive marker in the early diagnosis of HCC and whether the association of a-FP and SCCA could improves the diagnostic power.
Subjects and Methods: This study is conducted on 65 newly diagnosed hepatic focal lesion cases from those attending the Tropical Medicine Department, Cairo University Hospitals (Group I) as well as 20 age and sex matched healthy control subjects (Group II). Group I was further subdivided into Ia (49 HCC proved untreated patients) and Ib (16 patients with Cirrhosis only) according to their histopathological findings. All patients were subjected to full history taking, clinical examination, laboratory investigations (including liver function test, hepatitis markers, a-FP and SCCA serum levels), triphasic abdominal CT and pathological examination.
Results: Group I included 42 males (64.7%) and 23 females (35.3%) with ages ranging between 42-70 years (60.7±11.28), of them 16 patients had HBV (24.6%), 37 patients had HCV (56.9%) and 12 patients (18.4%) had mixed HBV and HCV infection. Group I was further subdivided into group Ia which included 49 HCC proved patients and group Ib which included 16 patients with regeneration nodules (cirrhosis only) according to their histopathologic findings. Group II (control) included 20 age and sex matched healthy subjects. Mean levels of serum a-FP and SCCA in group Ia was significantly higher when compared with group Ib (p<0.0005 for both of them). At a cutoff of serum a-FP 200 ng/mL, the sensitivity was 35% and the specificity was 100% while at a cutoff >400ng/mL, the sensitivity decreased to 7.6%. On using the receiver operator curve (ROC), to improve
the specificity and sensitivity of a-FP and SCCA, the cutoff value of 40ng/mI and 0.55ug/L yielded a sensitivity of 67.2% and 61.2% respectively and specificity of 100% (best cutoff). When combined sensitivity of them was calculated at the best-chosen cutoff values, sensitivity improved to 87.7% with specificity of 100%.
Conclusion: Combined use of a-FP and SCCA in the screening of patients with hepatic focal lesions may increase the chance of diagnosis of HCC patients.