Predictive Biomarkers of Hepatocellular Carcinoma in Sudanese Patients with Liver Cirrhosis

Abstract

Background: Liver cirrhosis (LC) is a prevalent condition in Sudan and the main predisposing factor for hepatocellular carcinoma (HCC). This study assesses the effectiveness of the use of α-fetoprotein (AFP), ultrasound (US), AFPmRNA in addition liver enzymes as early predictors for hepatocellular carcinoma (HCC) in Sudanese patients with liver cirrhosis (LC). Methods: A Hundred patients with LC, 25 patients with confirmed HCC and 50 healthy controls were included in the study. Serum AFP, AFPmRNA and liver enzymes were determined annually in patients with liver cirrhosis in addition to abdominal U/S for 3 years. Serum AFP was determined using enzyme immunoassay (EIA) in patients and controls. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used for detection of AFPmRNA. Results: During follow up hepatic nodules were identified in three liver cirrhotic patients (3%). AFP detection rate was higher (64%) at a low cut-off point (20ng/dl). the AFPmRNA had a very low sensitivity (24%) in HCC group. Only 3 patients developed HCC additionally to LC after follow up and all had positive AFPmRNA and AFP. Conclusions: In conclusion the combination of U/S, AFP and AFPmRNA would be the most effective tool for HCC screening in Sudan. However, AFPmRNA alone had the lowest detection rate and is therefore not recommended for screening.