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Serum soluble urokinase plasminogen activator receptor as a screening test for the early diagnosis of hepatocellular carcinoma
Author(s) -
Chounta Athina,
Ellinas Christofer,
Tzanetakou Vassiliki,
Pliarhopoulou Fani,
Mplani Virginia,
Oikonomou Angelos,
Leventogiannis Kostantinos,
GiamarellosBourboulis Evangelos J.
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12705
Subject(s) - hepatocellular carcinoma , medicine , cirrhosis , gastroenterology , liver biopsy , odds ratio , fibrosis , biopsy , prospective cohort study , plasminogen activator
Background & Aims Early detection of hepatocellular carcinoma ( HCC ) before imaging signs appear remains an unmet medical need. Former publications suggest that soluble urokinase plasminogen activator receptor (su PAR ) is a non‐specific cancer marker. su PAR was validated for the detection of patients at risk for HCC . Methods After an initial training set in 23 patients with extreme disease phenotypes, a prospective test set was conducted in which 267 patients without any imaging signs of HCC were followed up for 7 years. Patients were divided into low risk and high risk for the development of HCC by the EASL criteria. su PAR was measured at the beginning of follow‐up. All patients underwent liver biopsy to define staging of fibrosis. The primary study endpoint was to define a cut‐off among high‐risk patients by the EASL criteria that can early discriminate those at real risk for HCC . Results The training set showed that su PAR was significantly greater in patients with HCC even in the absence of underlying cirrhosis compared with patients with minimal liver inflammation because of fatty deposition. The test set showed that among the high‐risk EASL subgroup, su PAR more than 9.56 ng/ml had sensitivity 76.0%, specificity 90.4%, positive predictive value 54.3% and negative predictive value 96.2% for the development of HCC (odds ratio: 29.88, P < 0.0001). In survival analysis, patients with su PAR above 9.56 ng/ml at baseline progressed earlier to HCC . Conclusions The specificity and negative predictive value make serum su PAR a potential screening tool for the early detection of HCC in patients with chronic liver disorders.