Hatem Elalfy1, Tarek Besheer2, Mona M Arafa2, Mona Abo-Bakr El-Hussiny3, Mahmoud Abd El Latif4, Sahar Alsayed Mohamed Alsayed3. 1. Endemic Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt. elalfy_hatem66@yahoo.com. 2. Endemic Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt. 3. Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. 4. Radiological Diagnosis Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Abstract
BACKGROUND AND AIM: Extremely poor prognosis in hepatocellular carcinoma (HCC) patients with progressing disease was denoted by vascular invasion. Cytokeratin 18 (CK18) has been shown to be overexpressed in hepatocellular carcinoma so it is a valuable tumor marker; however, its role in vascular invasion is still unclear. This study aimed to predict CK18 as a predictive marker for macrovascular malignant invasion. METHODS: The present study was conducted on three groups of patients: group I included 91 HCC patients without macrovascular invasion, group II included 34 HCC patients with radiological evidence of vascular invasion, and group III included 110 control individuals subdivided into IIIA as healthy blood donors and IIIB as post-HCV cirrhotic patients without HCC. RESULTS: ROC curve of M30 fragments of CK18 was constructed for discrimination between HCC with and without macrovascular invasion. Optimum cutoff value was 304.5 ng/mL (AUC = 0.997, P < 0.001), sensitivity (100%) and specificity (98.8%). Regression analysis was conducted for prediction of macrovascular invasion within HCC patients. The following variables: higher levels of AST, M30, bilirubin, and AFP, lower levels of serum albumin, larger tumor size, child B score, and multiple lesions were associated with vascular invasion in univariate analysis. While in multivariate analysis, higher levels of AST and bilirubin and elevated levels of M30 and AFP serum were considered independent predictors for macrovascular invasion in HCC patients. CONCLUSION: The present study suggests that increased M30 fragments of CK18 levels may be useful as a possible marker of early tumor invasiveness.
BACKGROUND AND AIM: Extremely poor prognosis in hepatocellular carcinoma (HCC) patients with progressing disease was denoted by vascular invasion. Cytokeratin 18 (CK18) has been shown to be overexpressed in hepatocellular carcinoma so it is a valuable tumor marker; however, its role in vascular invasion is still unclear. This study aimed to predict CK18 as a predictive marker for macrovascular malignant invasion. METHODS: The present study was conducted on three groups of patients: group I included 91 HCC patients without macrovascular invasion, group II included 34 HCC patients with radiological evidence of vascular invasion, and group III included 110 control individuals subdivided into IIIA as healthy blood donors and IIIB as post-HCV cirrhotic patients without HCC. RESULTS: ROC curve of M30 fragments of CK18 was constructed for discrimination between HCC with and without macrovascular invasion. Optimum cutoff value was 304.5 ng/mL (AUC = 0.997, P < 0.001), sensitivity (100%) and specificity (98.8%). Regression analysis was conducted for prediction of macrovascular invasion within HCC patients. The following variables: higher levels of AST, M30, bilirubin, and AFP, lower levels of serum albumin, larger tumor size, child B score, and multiple lesions were associated with vascular invasion in univariate analysis. While in multivariate analysis, higher levels of AST and bilirubin and elevated levels of M30 and AFP serum were considered independent predictors for macrovascular invasion in HCC patients. CONCLUSION: The present study suggests that increased M30 fragments of CK18 levels may be useful as a possible marker of early tumor invasiveness.
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