Association of Serum Ferritin with Diabetes and Alcohol in Patients with Non-Viral Liver Disease-Related Hepatocellular Carcinoma

Abstract

Introduction: Non-alcoholic fatty liver disease is a leading cause for hepatocellular carcinoma (HCC) in Sri Lanka. Diabetes mellitus, alcohol abuse, and liver inflammation are known to increase the risk of HCC. The present study evaluates serum ferritin levels in a cohort of patients with non-viral HCC (nvHCC). Methodology: Consecutive patients with nvHCC presenting to the Colombo North Liver transplant Service, Ragama, from January 2012 to July 2013 were investigated. All were negative for hepatitis B and C. At registration, 5 mL of serum was separated into plain tubes, stored at -80 ° C and analysed for ferritin using an enzyme-linked immunosorbent assay. Correlation between the serum ferritin and patient risk factors, liver status, and tumour characteristics were analysed. Results: There were 93 patients with nvHCC (median age 65 [12-82] years; 82 [88.2%] males). The median ferritin level was 246.2 μg/L, and 38 (40.86%) patients had elevated ferritin. Non-diabetics (median 363.5 mg/L, p = 0.003) and alcohol abusers (median 261.2 mg/L, p = 0.018) had higher ferritin levels. On multiple-variable analysis, being non-diabetic ( p = 0.013) and alcoholic ( p = 0.046) was significantly associated with high serum ferritin. No association was found with body mass index, tumour stage, size, macrovascular invasion, number of nodules, alpha-fetoprotein, bilirubin, international normalized ratio, and survival. Conclusion: In patients with nvHCC, serum ferritin levels are higher in non-diabetics and alcoholics.

A new discovery of STAT4 single nucleotide polymorphisms associated with hepatocellular carcinoma risk in Chinese Han population: a case–control study

“…Although there were studies found that SF levels may not play a role in the identification and diagnosis of HCC (34,35), other studies have also shown that it may be a marker for monitoring chemotherapy response in patients with HCC (33). Facciorusso A et al also found that the prognosis of HCC patients with higher SF levels was poor (36).…”

Mechanisms of hepatocellular carcinoma progression

“…In this context, a possible tumor biomarker may be serum ferritin rather than iron. However, because there is no exact correlation between iron inside the liver and iron in the blood, it is difficult to clarify the pathological features of ferritin on the poor prognosis of non-viral HCC (nvHCC)[24]. Results of a cohort study of 93 patients with nvHCC, 62 of whom had alcohol abuse problems, showed an increase in ferritin level in non-diabetics[24].…”

“…However, because there is no exact correlation between iron inside the liver and iron in the blood, it is difficult to clarify the pathological features of ferritin on the poor prognosis of non-viral HCC (nvHCC)[24]. Results of a cohort study of 93 patients with nvHCC, 62 of whom had alcohol abuse problems, showed an increase in ferritin level in non-diabetics[24]. However, further research needs to be done to assess the correlation between the impacts of alcohol and ferritin on NAFLD[24].…”

“…Results of a cohort study of 93 patients with nvHCC, 62 of whom had alcohol abuse problems, showed an increase in ferritin level in non-diabetics[24]. However, further research needs to be done to assess the correlation between the impacts of alcohol and ferritin on NAFLD[24].…”

PIVKA-II as a Potential New Biomarker for Hepatocellular Carcinoma – A Pilot Study

“…Carcinogenesis of HCC is multifactorial and includes previous infection with hepatitis B or C viruses (HBV, HCV), aflatoxin B or alcohol consumption resulting in liver cirrhosis (4). New cancer sometimes develops with no previous link to the abovementioned agents, sometimes non-alcoholic steatohepatitis in diabetic patients has been associated with liver cancer (5).…”