Diagnostic and prognostic value of serum copper and plasma fibrinogen in hepatic carcinoma.

To investigate the diagnostic and prognostic value of several biochemical tests in primary liver tumors, the authors studied 36 cases (4 cholangiocarcinomas and 32 hepatocellular carcinomas, 10 of which were associated with cirrhosis) and 47 cases of liver cirrhosis, all with morphologically proven diagnosis. Serum copper (SCu) and plasma fibrinogen (PF) appeared the most useful tests in differential diagnosis between tumors and cirrhosis. In liver tumors, mean SCu level was 200.50, standard deviation (SD) 47.17 micrograms/dl (121.40, SD 25.90 micrograms/dl in cirrhosis; P less than 0.001). PF level was 461.78, SD 151.25 mg/dl in tumors (275.30 SD, 124.40 mg/dl in cirrhosis; P less than 0.001). SCu had a good sensitivity (0.80) and a high specificity (0.92) at a cutoff value of 160 micrograms/dl; when the cutoff level was raised to 170 micrograms/dl, the specificity increased to 1, with a sensitivity of 0.77. The combination of SCu and PF improved the diagnostic value slightly. Moreover, with an estimated frequency of tumor in cirrhosis of 10%, SCu had a positive predictive value of 1 (cutoff, 170 micrograms/dl) and a negative predictive value of 0.97. In nine patients SCu levels decreased after surgical removal of tumor; five other patients, sequentially studied, showed an increase of SCu level that correlated with the progression of the disease. Finally, patients with longer survival had a lower SCu level. These findings suggest that SCu level may be used as a screening test for early detection of neoplastic degeneration, and it is correlated with the extension of tumor mass.