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World J Hepatol. Oct 18, 2015; 7(23): 2474-2481
Published online Oct 18, 2015. doi: 10.4254/wjh.v7.i23.2474
Role of biomarkers in the prediction and diagnosis of hepatocellular carcinoma
Mahmoud Khattab, Magdy Fouad, Elham Ahmed
Mahmoud Khattab, Elham Ahmed, Internal Medicine Department, Minia University, Minia 61111, Egypt
Magdy Fouad, Tropical Medicine Department, Minia University, Minia 61111, Egypt
Author contributions: All authors equally contributed to acquiring the data, reviewing the literature, drafting the article, making critical revisions to the manuscript, and approving of the final version of the article to be published.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to be declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mahmoud Khattab, MD, PhD, Professor of Medicine, Head of Liver Unit, Internal Medicine Department, Minia University, Main Road - Shalaby Land, Minia 61111, Egypt. mkhattabmed@hotmail.com
Telephone: +20-2-5197818 Fax: +20-86-2319040
Received: December 1, 2014
Peer-review started: December 2, 2014
First decision: January 12, 2015
Revised: August 24, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: October 18, 2015
Processing time: 321 Days and 22.1 Hours
Abstract

The prevalence of hepatocellular carcinoma (HCC) has progressively increased in recent years and is now the fifth and the second most common cancer in the World and in Egypt, respectively. Much work has focused in the development of assays for detecting hepatic carcinogensis before the observance of hepatic focal lesions. Particular attention has been directed towards HCC-specific biomarkers for use in the early diagnosis of HCC and in the confirmation of radiological studies. Although a number of biomarkers have been identified, none have been considered reliable indicators of early HCC lesions. This review presents a few of the most relevant HCC biomarkers and suggests improvements to the accuracy of diagnostic assays through their combined use. Furthermore, we present an algorithm for the biomarker-based diagnosis of HCC and highlight its important role in the early prediction of HCC.

Keywords: Hepatocellular carcinoma; Epidemiology; Pathogenesis; Biomarkers; Diagnosis

Core tip: Alpha-fetoprotein (AFP) has been widely used as a reference biomarker to validate the diagnosis of hepatocellular carcinoma (HCC). However, normal physiological-levels of AFP are observed in approximately one third of HCC cases. Furthermore, a number of HCC positive patients have AFP levels less than the threshold value of 400 ng/mL. These factors make an AFP-based diagnosis of HCC far from reliable. However, high diagnostic accuracy indices have been reported when AFP is combined with other biomarkers such as midkine, golgi protein 73, des-γ-carboxyprothrombin, glypican-3, and gamma-glutamyl transferase.