Human Chorionic Gonadotropin-Beta in the Differentiation of Malignancy-Related and Nonmalignant Ascites

Abstract

The clinical value of the tumor marker human chorionic gonadotropin-beta (hCG-β) in ascitic fluid for the differentiation of malignancy-related and nonmalignant ascites was evaluated. Ascitic fluid protein, cholesterol and cytological examination were determined for comparison. Thirty-six patients with malignancy-related ascites (27 peritoneal carcinomatosis, 9 miscellaneous malignant causes without peritoneal carcinomatosis) and 69 patients with nonmalignant ascites (55 with liver cirrhosis, 14 with miscellaneous nonmalignant causes) were investigated. hCG-β concentrations were elevated in malignant samples and with a cut-off value of 10 mlU/ml hCG-β yielded a sensitivity of 61 %, specificity of 94% and efficiency of 83%. Ascitic fluid protein (cutoff value 3.0 g/l00 ml) and cholesterol (cut-off value 45 mg/l00 ml) concentrations showed a sensitivity of 64%/83%, specificity of 77%/81% and efficiency of 72%/82%. The combination of hCG-β and cytological examination yielded 89.5% differential diagnostic efficiency, superior to the combinations of protein and cytology or protein and hCG-β. hCG-β tended to be superior to protein/cholesterol determination regarding sensitivity (44% vs. 50%/33%) and specificity (79% vs. 50%/57%) in the subgroups of patients with miscellaneous causes of ascites. In conclusion, hCG-β is frequently elevated in malignancy-related ascites and seems to be as useful a parameter as total protein for the differentiation of malignancy-related from nonmalignant ascites.

Pathogenesis, Diagnosis and Treatment of Ascites in Cirrhosis

“…The concentration of lactic dehydrogenase in malignant ascites is higher than the corresponding values in plasma because of leakage of the enzyme from the malignant cells lining the peritoneum, whereas the reverse is the rule for cirrhotic ascites [44]. Other measurements in ascitic fluid that have proved to be of value in differentiating malignant from cirrhotic ascites include total lipids, free fatty acids, cholesterol, fibronectin, carcinoembryonic antigen and other tumour-associated antigens, urokinase, tissue plasminogen activator, plasminogen activator inhibitor and fibrin/fibrinogen degradation products, and human chorionic gonadotropin-β [40,[43][44][45][46][47][48]. 1) [40,44].…”