Comparison of diagnostic performance of AFP, DCP and two diagnostic models in hepatocellular carcinoma: a retrospective study

Combining AFP, PIVKA-II, and GP73 has diagnostic utility for hepatitis B-associated hepatocellular carcinoma and is consistent with liver pathology results

Although liquid biopsy has garnered increasing attention in recent years for diagnosing hepatocellular carcinoma (HCC), serum biomarkers continue to hold significant value for HCC diagnosis due to their simple operation, cost-effectiveness, and high efficiency. This study aimed to screen for the optimal diagnostic combinations of alpha fetoprotein (AFP), a protein induced by vitamin K deficiency or antagonist II (PIVKA-II), golgi glycoprotein 73 (GP73), and routine clinical indicators for diagnosing hepatitis B-associated HCC (HBV-HCC). A retrospective analysis was conducted on 358 HBV-HCC patients treated at Taizhou People's Hospital from August 2015 to October 2021; 124 patients with chronic hepatitis B (CHB) and 241 patients with hepatitis B cirrhosis composed the control group. With liver pathology as the gold standard, the concordance between the screened indicators and liver pathology for HCC diagnosis was analyzed by Cohen's kappa coefficient. In the CHB group, AFP, PIVKA-II, and GP73 were statistical significance, and the triple biomarker combination achieved the highest AUC (0.908) for HCC diagnosis, surpassing the efficacy of both individual indicators and two biomarker combinations. In both the Child‒Pugh A and Child‒Pugh B&C cirrhosis groups, AFP and PIVKA-II were significantly different between patients with and without HCC, and the AUC values of AFP combined with PIVKA-II for HCC diagnosis were 0.969 and 0.956, respectively. Using liver pathology as the gold standard, the Kappa values of the above combinations in the three groups were 0.866, 0.780, and 0.800, respectively. The triple combination of AFP, PIVKA-II, and GP73 in the CHB group and the combination of AFP and PIVKA-II in both the Child‒Pugh A and Child‒Pugh B&C cirrhosis groups had excellent diagnostic accuracy for HCC, consistent with liver pathology, and were superior to the diagnostic ability of individual biomarkers.

Advances in application of serum biomarkers for screening and early diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents a major global health challenge, with early detection through surveillance of high-risk populations remaining critical for improving clinical outcomes. Serum biomarkers play a crucial role in the early detection of HCC. Currently, commonly used serological markers for HCC include alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin, and the Lens culinaris agglutinin-reactive fraction of AFP. Other potential biomarkers under investigation include glypican-3, osteopontin, alpha-L-fucosidase, Dickkopf-1, heat shock protein 90α, and Golgi protein 73. With the advancement of liquid biopsy technologies, novel markers such as circulating tumor DNA, circulating tumor cells, microRNAs, and long non-coding RNAs have emerged as promising tools for early screening and diagnosis of HCC. This review aims to summarize the research progress and clinical applications of these biomarkers related to liver cancer, providing scientific evidence to enhance early diagnosis rates, improve prognosis, and ultimately reduce HCC-related mortality.

Accurate quantification of cell-free Ceruloplasmin mRNA as a biomarker for early detection of hepatocellular carcinoma

Accurate and early detection of hepatocellular carcinoma (HCC) is critical for improving patient outcomes. Current biomarkers like AFP have limited sensitivity, necessitating novel diagnostic markers. A novel semi-nested RT-PCR assay was developed to quantify circulating Ceruloplasmin (CP) mRNA in peripheral blood. This method co-amplifies CP mRNA and an internal control (IC) gene, followed by DNA melting analysis to distinguish and quantify CP mRNA. CP mRNA levels were significantly higher in the HCC group (median: 3.37) compared to both the CLD group (0.24, p = 0.0066) and the HD group (0.17, p < 0.0001). Further analysis using ROC curves highlighted the diagnostic performance of the assay. For differentiating HCC from CLD, the area under the ROC curve (AUC) was 0.704, with 50.98% sensitivity and 95.24% specificity. In comparison to HD, the AUC was 0.812, with 74.51% sensitivity and 80.65% specificity. Against the combined control group (CLD and HD), the AUC was 0.768, with 50.98% sensitivity and 96.15% specificity. Additionally, in 59.1% of HCC cases with AFP levels below 20 ng/mL, CP mRNA levels were elevated, indicating that CP mRNA could help detect a substantial proportion of AFP-negative HCC cases. This study, the first comprehensive clinical investigation of cell-free CP mRNA for HCC diagnosis, demonstrates its potential as a sensitive and specific non-invasive biomarker. Further validation in larger cohorts is needed to confirm its clinical utility.

Current Advancements in Serum Protein Biomarkers for Hepatitis B Virus-Associated Hepatocyte Remodeling and Hepatocellular Carcinoma

BACKGROUND

Hepatitis B virus (HBV)-related liver cancer is the third most common cause of cancer-related death globally. Hepatocyte remodeling, also known as hepatocyte transformation and immortalization, and hepatocellular carcinoma (HCC), are brought on by persistent inflammation caused by HBV in the host hepatocytes. One of the main concerns in the perspective of HBV-induced hepatocyte remodeling and liver cancer is accurately identifying cancer stages to maximize early screening and detection. Biological signatures have a significant impact on solving this problem.

OBJECTIVE

This review article aimed to discuss the novel serum protein biomarkers for HBV-induced hepatocyte remodeling and HCC.

METHODS

The information was collected from various peer-reviewed journals through electronic searches utilizing various search engines, including PubMed, Google Scholar, HINARI, and Cochrane Library from 2017 to 2024. Keywords for searches included "serum protein biomarkers in HBV-HCC," "blood-based biomarkers in HBV-HCC," and "viral biomarkers for HBV-HCC."

RESULTS

Recently, novel protein signatures have been discovered for the early diagnosis, treatment, and prognosis of HBV-induced hepatic cell remodeling and HCC from proteomic data sets. We have discussed the recent literature on the clinical utility of the protein signatures for the diagnosis and forecasting of HBV-associated hepatocyte remodeling and HCC, including golgi protein 73 (GP73), glypican-3 (GPC3), midkine (MDK), des-γ-carboxy-prothrombin (DCP), von Willebrand factor (vWF), pentraxin 3 (PTX3), pseudouridine synthases 7 (PUSs 7), squamous cell carcinoma antigen (SCCA), and osteopontin (OPN).

CONCLUSION

All these protein markers also exhibit the survival of HBV-related HCC patients, the proliferation, migration, antiapoptosis, mitogenesis, transformation, and angiogenesis of HBV-infected hepatocytes.

Alpha-fetoprotein: Past, present, and future

Alpha-fetoprotein (AFP) is a glycoprotein that plays an important role in immune regulation with critical involvement in early human development and maintaining the immune balance during pregnancy. Postfetal development, the regulatory mechanisms controlling AFP undergo a shift and AFP gene transcription is suppressed. Instead, these enhancers refocus their activity to maintain albumin gene transcription throughout adulthood. During the postnatal period, AFP expression can increase in the setting of hepatocyte injury, regeneration, and malignant transformation. It is the first oncoprotein discovered and is routinely used as part of a screening strategy for HCC. AFP has been shown to be a powerful prognostic biomarker, and multiple HCC prognosis models confirmed the independent prognostic utility of AFP. AFP is also a useful predictive biomarker for monitoring the treatment response of HCC. In addition to its role as a biomarker, AFP plays important roles in immune modulation to promote tumorigenesis and thus has been investigated as a therapeutic target in HCC. In this review article, we aim to provide an overview of AFP, encompassing the discovery, biological role, and utility as an HCC biomarker in combination with other biomarkers and how it impacts clinical practice and future direction.

Cytokine profiles and virological markers highlight distinctive immune statuses, and effectivenesses and limitations of NAs across different courses of chronic HBV infection

PURPOSE

The characteristics of cytokine/chemokine(CK) profiles across different courses of chronic hepatitis B virus infection and the effects of NAs antiviral therapy on cytokine profiles remain unclear.

METHODS

This report provides evidence from 383 patients with chronic HBV infection. The Luminex multiple cytokine detection technology was used to detect CK profiles. The predictive power of CKs across course of disease was assessedusing univariate analyses and with receiver operating characteristic (ROC) curves.

RESULTS

Compared to healthy control (HC), expression levels of interleukin 6 (IL)-6, IL-8, IL-21, matrix metalloproteinases (MMP)-2 and tumor necrosis factor receptor (TNFR)-1 showed a significant increasing trend during chronic HBV infection. IL-23 and IL-33 increased respectively in chronic hepatitis B patients (CHB). interferon (IFN)-gamma and TNF-α changed significantly only in liver cirrhosis (LC) patients. Whereas, myeloid-related markers decreased dramatically in those with hepatocellular carcinoma (HCC). The ROC result suggests that combining IL-6, IL-8, CXCL9 and CXCL13 into a nomogram has closely correlation with HCC during chronic HBV infection. In addition, nucleotide analogues (NAs) antiviral treatments are capable of recoveringnormal liver functions and significantly reducing the viral loads, however, they seem to have a limited effect in changing CKs, especially specific antiviral factors.

CONCLUSION

The differential CK and virological markers may serve as potential indicators of distinct immune statuses in chronic HBV infection. They also underscore the varying efficacy and limitations of NAs antiviral therapies. This next step would to break new ground in the optimization of current anti-HBV treatment programs although this requires further research.

Protein induced by vitamin K absence or antagonist II: Experience to date and future directions

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer with high mortality. The realization of precision medicine in HCC relies upon efficient biomarkers. Protein induced by vitamin K absence or antagonist II (PIVKA-II) is an immature prothrombin with insufficient coagulation activity, overexpressing in HCC cells. Previous evidence confirmed the role of PIVKA-II in screening and diagnosing HCC. However, the increased PIVKA-II was observed not only in HCC, but also in non-HCC individuals such as vitamin K deficiency. The joint detection of PIVKA-II and other biomarkers could significantly improve diagnostic accuracy in HCC. Furthermore, PIVKA-II serves as a valuable prognostic predictor, transplantation eligibility, resectability, tumor recurrence, therapeutic efficacy, and malignant tumor behaviors. Additionally, PIVKA-II represents a potential target for agent development to establish new therapeutic strategies. Besides HCC, PIVKA-II also serves as a biomarker of vitamin K status. In this review, we assess the role of PIVKA-II in diagnosis, prediction, and treatment. Over the past decades, substantial progress has been achieved in the application of PIVKA-II. Exploration and innovation are required for further advances in the field of PIVKA-II investigation.