Brief Reports
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2005; 11(13): 1987-1990
Published online Apr 7, 2005. doi: 10.3748/wjg.v11.i13.1987
Serum chromogranin-A in hepatocellular carcinoma: Diagnostic utility and limits
Aldo Spadaro, Antonino Ajello, Carmela Morace, Agata Zirilli, Graziella D’arrigo, Carmelo Luigiano, Francesco Martino, Anna Bene, Domenico Migliorato, Santi Turiano, Oscar Ferraù, Maria Antonietta Freni
Aldo Spadaro, Antonino Ajello, Carmela Morace, Carmelo Luigiano, Domenico Migliorato, Santi Turiano, Oscar Ferraù, Maria Antonietta Freni, Dipartimento Clinico Sperimentale di Medicina e Farmacologia, Università di Messina, Italy
Agata Zirilli, Graziella D’arrigo, Dipartimento di Statistica, Università di Messina, Italy
Francesco Martino, Dipartimento di Scienze Radiologiche, Università di Messina, Italy
Anna Bene, Unità Operativa di Gastroenterologia, Azienda Ospedaliera Universitaria di Messina, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Aldo Spadaro, Dipartimento Clinico Sperimentale di Medicina e Farmacologia, Clinica Medica, Pad. C, AOU, Via Consolare Valeria No. 1, 98125 Messina, Italy. aldo.spadaro@unime.it
Telephone: +39-90-2212333 Fax: +39-90-693917
Received: September 23, 2004
Revised: September 24, 2004
Accepted: December 8, 2004
Published online: April 7, 2005
Abstract

AIM: The utility of serum alpha-fetoprotein (α-FP) for the detection of hepatocellular carcinoma (HCC) is questionable. High serum levels of chromogranin-A (CgA) have recently been reported in HCC. Impaired hepatic, renal, and heart functions influence circulating CgA. The aim of this study was to assess sensitivity and specificity of serum CgA as a marker of HCC in patients with liver cirrhosis (LC).

METHODS: Serum CgA levels were measured by RIA in 339 patients of which 54 HCC, 132 LC, 45 chronic hepatitis (CH), 27 chronic heart failure (CHF), 36 chronic renal failure (CRF), 45 chronic inflammatory bowel disease (IBD) as disease controls and in 75 healthy controls. Patients with liver disease or IBD and concomitant renal and/or heart failure were excluded. Pearson correlation, non-parametric combination test and confidence interval analysis were used for statistical analysis.

RESULTS: Serum CgA above normal values (100 ng/mL) were found in 83% of HCC patients, in 48% of LC patients, in 20% of CH patients, in 33% of IBD patients, in 92% of CRF patients, in 100% of CHF patients, and in none of the healthy controls. The mean CgA values in HCC (769±1 046), in LC (249±369), in CH (87±94), in CRF (1390±1401), in CHF (577±539), in IBD (146±287) were significantly higher than those in healthy controls (48±18). HCC patients had higher CgA values (P<0.01) than LC, CH, and IBD patients but did not differ from those with CRF or CHF. The 95% CI for the mean (250-1289 ng/mL) in HCC patients was selected as a CgA range and the lower value of such range was assumed as cut-off. Sensitivity and specificity of CgA, calculated in relation to the cut-off in patients with cirrhosis and HCC, were respectively 61% (CI 48-73%) and 82% (CI 75-88%). Serum α-FP values were >200 ng/mL in 21% of the HCC patients and in none of the LC patients. No significant correlation was found between α-FP and CgA in patients with HCC and in patients with cirrhosis.

CONCLUSION: When HCC is suspected and α-FP is normal or <200 ng/mL, CgA serum values represent a complementary diagnostic tool, unless kidney or heart failure is present.

Keywords: Chromogranin-A; Hepatocellular carcinoma; Liver cirrhosis; Chronic hepatitis; Diagnosis