Journal of Clinical and Cellular Immunology
Open Access
ISSN: 2155-9899
ISSN: 2155-9899
Amel Mahmoud Kamal Eldin, Manal Mohamed Saber, Aliaa Higazi, Amal Kamal Helmy, Hala Ibrahem Mohamed and Asmaa Ahmed Aly
Background: Hepatocellular carcinoma (HCC) is the leading cause of death in HCV-related liver diseases and the third most common cause of cancer-related mortality worldwide. A reliable serum marker for early diagnosis of HCC is currently lacking.
Objectives: The aim of this study was to identify the serum levels of soluble Human leukocyte antigen-G (sHLAG) in HCC and liver cirrhosis (LC) patients. As well, we aimed to estimate the diagnostic performance of sHLA-G for HCC by comparing its levels with the levels of Alpha fetoprotein (AFP).
Subjects and methods: The study included 100 subjects divided into: 25 apparently healthy volunteers who served as healthy control subjects (group I), and 50 patients with untreated HCC on top of liver cirrhosis (group II) in addition to 25 cirrhotic patients (group III). HCC group was divided into two subgroups, 25 patients with AFP levels ≤ 200 ng/ml and 25 patients with AFP levels >200 ng/ml. All subjects were subjected to routine laboratory investigations plus detection of serum levels of both AFP and sHLA-G by Enzyme Immune Assay (EIA).
Results: Blind parallel detection was conducted for sHLA-G and AFP. AFP was highly significantly increased in HCC and LC patients when compared to healthy controls (p=0.001). Also, there was a highly significant increase in AFP level in HCC patients when compared to cirrhotic ones (p=0.001). sHLA-G was highly significantly increased in HCC patients when compared to both healthy controls and cirrhotic patients (p=0.001). sHLA-G was not significantly increased in cirrhotic patients when compared to healthy controls (p=0.001). There was a significant strong positive correlations between sHLA-G and AFP in HCC patients (p<0.001) while weak negative correlation between sHLA-G and AFP was detected in cirrhotic group. The area under the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacies of both markers. The superiority of sHLA-G over AFP was more profound in the diagnosis of HCC [AUC: 0.993], in discriminating HCC from LC patients [AUC: 0.992] as well as in the diagnosis of HCC patients with AFP levels ≤ 200 ng/ml or in discriminating this HCC subgroup from LC patients [AUC: 0.986 and 0.984 respectively].
Conclusion: sHLA-G was found to be superior over AFP because of its higher AUC than that of AFP. As well, sHLA-G has better diagnostic performance with higher sensitivity and specificity than AFP. According to our data, sHLA-G could serve as a new efficient marker for early diagnosis of HCV-related HCC patients and to discriminate HCC from LC patients. Thus, measuring sHLA-G levels can help to reduce both false negative and false positive rates of AFP. Moreover, sHLA-G could have predictive value for tumorogenesis in HCV-related LC patients and could be used along with other tumor markers for early detection of malignant transformation.