Diagnostic Performance of Epithelial Cell Adhesion Molecule for Early Detection of Hepatocellular Carcinoma Among HCV High-Risk Patients

Abstract

Objective: Hepatocellular carcinoma (HCC) is often diagnosed at advanced stage where hopeless for effective therapies. Identification of more reliable biomarkers for early detection of HCC is urgently needed. Circulating tumor cells (CTCs) represent a unique liquid biopsy carrying comprehensive biological information of the primary tumor. Herein, we sought to develop a novel score based on the combination of the most significant CTCs biomarkers with routine laboratory tests for accurate detection of HCC.

Material & methods: Epithelial cell adhesion molecule (EpCAM), α-fetoprotein, albumin, and platelets count were assayed in HCC patients (98), liver cirrhosis patients (77). Areas under receiving operating curve (AUCs) were calculated and used for construction on novel score.

Results: A novel score named EpCAM-HCC = AFP (U/L) × 0.11 - Albumin (g/dl) × 1.5 + EpCAM % × 2.9 - Platelets count (×10⁹)/L× 0.75 - 93. EpCAM-HCC score produce AUC of 1 for differentiate patients with HCC from those with liver cirrhosis with sensitivity and specificity of a cut-off 1.7 (i.e., less than 1.7 the case is considered cirrhotic, whereas above 1.7 it is considered HCC.

Conclusion: EpCAM-HCC score could replace AFP during screening of HCV patients and early detection of HCC.

Keywords: CTCs; EpCAM; HCV; Hepatocellular carcinoma.

Figure 1

Flow Cytometry Histogram for Frequency of CTCs Biomarker, (EpCAM): A. EpCAM+ for Patients with Chronic Hepatitis, B. EpCAM+ for Patient with Hepatocellular Carcinoma

Figure 2

Area under the ROC Curves of Candidate Biomarkers for Discrimination between Chronic Hepatitis and Hepatocellular Carcinoma Patients

Figure 3

Area under the ROC Curve for EpCAM-HCC Score for One Marker (AFP), Two Parameters (AFP and EpCAM), Three Parameters (AFP, EpCAM and Platelets Count) and Four Parameters (AFP, EpCAM, Platelets Count and Albumin)