Observational Study
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World J Hepatol. Mar 27, 2022; 14(3): 623-633
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.623
Assessment of fibroblast growth factor 19 as a non-invasive serum marker for hepatocellular carcinoma
Ghada Abdelrahman Mohamed, Ehab Hasan Nashaat, Hadeer Mohamed Fawzy, Ahmed Mohamed ElGhandour
Ghada Abdelrahman Mohamed, Ehab Hasan Nashaat, Hadeer Mohamed Fawzy, Ahmed Mohamed ElGhandour, Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
Author contributions: Mohamed GA, Nashaat EH, and ElGhandour AM designed the study; Fawzy HM participated in the acquisition of the data; Mohamed GA, Nashaat EH, Fawzy HM, and ElGhandour AM participated in the analysis and interpretation of the data; Mohamed GA, Nashaat EH, Fawzy HM, and ElGhandour AM revised the article critically for important intellectual content; Mohamed GA wrote the manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board of Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Informed consent statement: Informed consent was obtained from every participant before the enrollment into the study.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: The statistical code and dataset are available from the corresponding author at ghadaabdelrahman@med.asu.edu.eg. The participants gave informed consent for the data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ghada Abdelrahman Mohamed, MD, Lecturer, Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Ain Shams University, El Khalifa El-Maamon St., Abbassia, Cairo 11591, Egypt. ghadaabdelrahman@med.asu.edu.eg
Received: October 19, 2021
Peer-review started: October 19, 2021
First decision: December 3, 2021
Revised: December 19, 2022
Accepted: February 20, 2022
Article in press: February 20, 2022
Published online: March 27, 2022
Processing time: 156 Days and 13.6 Hours
Abstract
BACKGROUND

Fibroblast growth factor 19 (FGF-19) is one of the founding members of the endocrine FGF subfamily. Recently, it has been the subject of much interest owing to its role in various physiological processes affecting glucose and lipid metabolism and the regulation of bile acid secretion as well as cell proliferation, differentiation, and motility. Additionally, FGF-19 secretion in an autocrine style has reportedly contributed to cancer progression in various types of malignancies including hepatocellular carcinoma (HCC).

AIM

To estimate the serum FGF-19 concentrations in HCC cases and assess its diagnostic performance for the detection of HCC.

METHODS

We recruited 90 adult participants and divided them into three equal groups: Healthy controls, cirrhosis patients, and HCC patients. Serum FGF-19 concentrations were measured using the Human FGF-19 ELISA kit.

RESULTS

We detected a high statistically significant difference in serum FGF-19 levels among the three groups. The highest level was observed in the HCC group, followed by the cirrhosis and control groups (236.44 ± 40.94 vs 125.63 ± 31.54 vs 69.60 ± 20.90 pg/mL, respectively, P ≤ 0.001). FGF-19 was positively correlated with alpha fetoprotein (AFP; r = 0.383, P = 0.003) and international normalised ratio (r = 0.357, P = 0.005), while it was negatively correlated with albumin (r = -0.500, P ≤ 0.001). For the detection of HCC, receiver operating characteristic curve analysis showed that the best cut-off point of AFP was > 8.2 ng/mL with an area under the curve (AUC) of 0.78, sensitivity of 63.33%, specificity of 83.33%, positive predictive value (PPV) of 79.2%, negative predictive value (NPV) of 69.4%, and total accuracy of 78%. However, FGF-19 at a cut-off point > 180 pg/mL had an AUC of 0.98, sensitivity of 100%, specificity of 90.0%, PPV of 90.0%, NPV of 100%, and total accuracy of 98%.

CONCLUSION

FGF-19 represents a possible novel non-invasive marker for HCC. It may improve the prognosis of HCC patients due to its utility in several aspects of HCC detection and management.

Keywords: Fibroblast growth factor 19; FGF-19; Fibroblast growth factors; Tumour biomarkers; Hepatocellular carcinoma; Detection; Cirrhosis

Core Tip: We recruited 90 adult participants and divided them into three equal groups: Healthy controls, cirrhosis patients, and hepatocellular carcinoma (HCC) patients. We detected a high statistically significant difference in fibroblast growth factor 19 (FGF-19) levels among the three groups, with the highest level occurring in the HCC group, followed by the cirrhosis and control groups (236.44 ± 40.94 vs 125.63 ± 31.54 vs 69.60 ± 20.90 pg/mL, respectively, P ≤ 0.001). For the detection of HCC, receiver operating characteristic curve analysis showed that FGF-19 demonstrated a better diagnostic performance than alpha fetoprotein (area under the curve = 0.98 vs 0.78). Consequently, we can conclude that FGF-19 represents a possible novel non-invasive marker for HCC.