Challenges of liver cancer: Future emerging tools in imaging and urinary biomarkers

Table 1 Examples of serum markers for the assessment of fibrosis

Name	Constituents	Accuracy (%)
		Se	Sp	PPV	NPV
Indirect markers
APRI	AST, platelets	41	95	88	64
FibroTest	α2 macroglobulin, α2 and γ globulin, total bilirubin, apolipoprotein A1, γGT	87	59	63	85
Direct markers
ELF	PIIINP, HA, TIMP-1, (age)	90.5	41	99	92
FibroSpect	HA, TIMP-1, γ2 macroglobulin	77	73	74	76

APRI: Aspartate aminotransferase (AST) to platelet ratio index; γGT: γ-glutamyl transpeptidase; HA: Hyaluronic acid; PIIINP: Amino terminal of procollagenase III; TIMP-1: Tissue inhibitor of matrix metalloproteinase 1; ELF: Enhanced Liver Fibrosis test; Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value.

Table 2 Urinary markers of hepatocellular carcinoma

Year	Urinary biomarker
Nucleosides and nucleotides
1974	Methylated purines[45]
1976	Cyclic GMP[46,47]
1986	Pseudouridine[48,49]
Proteins and polyamines
1990	TGFα and β[50-52]
1998	Neopterin[53-56]
2004	Urinary trypsin inhibitor[59,60]
1998	Spermine, putrescine, spermidine[58]
Metabolite profiles
2009	Octanedioic acid, glycine and hypoxanthine[61]
2010	Creatinine, carnitine, creatine[62]

GMP: Guanosine 3’:5’ monophosphate; TGF: Transforming growth factor.