Ascitic Calprotectin as an early predictor of hepatocellular carcinoma in patients with cirrhotic ascites
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ORIGINAL ARTICLE – CANCER RESEARCH
Ascitic Calprotectin as an early predictor of hepatocellular carcinoma in patients with cirrhotic ascites Amr Shaaban Hanafy1 · Mohamed Sorour Mohamed1 · Ahmed A. Alnagar2 Received: 13 June 2020 / Accepted: 18 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Calprotectin is a heterodimer formed by S100A8 and S100A9 proteins which are enhanced during hepatic carcinogenesis and the increased expression of both proteins promotes malignant progression of hepatocellular carcinoma. The potential correlation between ascitic Calprotectin and HCC was not studied. Methods 100 patients were stratified into a case group which enrolled 50 patients with cirrhotic ascites and documented HCC and a control group consisted of 50 patients with cirrhotic ascites without HCC. They were evaluated by liver function tests, abdominal ultrasound and routine ascitic fluid examination including ascetic Calprotectin and results were validated in another group (n = 100). Results Calprotectin level was significantly higher in the HCC group with insignificant difference regarding total cell count, PNLs, ascitic albumin, LDH, CEA and SAAG. It correlated with serum creatinine (r = 0.245, p = 0.014) and number of focal hepatic lesions (r = 0.309, p = 0.002). In the validation group, 28 patients had elevated ascitic Calprotectin of which 21 patients had developed HCC (75%) after a mean period of 3.8 ± 1.54 months. A cut of value 126 ng/ml was accurate to predict HCC in liver cirrhosis with ascites with a sensitivity of 93.3% specificity 94%, AUC 0.950, Youden’s J value = 0.873, p = 0.0001. Conclusion Ascitic Calprotectin may offer an easy, affordable marker that can predict the early occurrence of HCC. Keywords Ascites · Cirrhosis · Calprotectin · Hepatocellular carcinoma · Prediction · HCV · Focal lesion · Ultrasound · Early · Prevention Abbreviations USG Abdominal ultrasonography CEA Carcinoembryonic antigen HCC Hepatocellular carcinoma ROC Receiver operator characteristics PNLs Polymorphonuclear neutrophils SAAG Serum-ascites albumin gradient SBP Spontaneous bacterial peritonitis
* Amr Shaaban Hanafy [email protected] 1
Internal Medicine Department, Hepatogastroenterology Division, Zagazig University, Zagazig, 40 Mostafa Fouad street 44519, Egypt
Medical Oncology, Zagazig University, Zagazig, Egypt
2
Introduction Hepatocellular carcinoma (HCC) is one of the most common lethal cancers; early detection is of great importance for a better outcome and increased survival. Calprotectin is a heterodimer formed by S100A8 and S100A9 proteins (Lehmann et al. 2014). It constitutes about 60% of the soluble protein content of the neutrophilic cytosol (Striz and Trebichavsky 2004). It exerts its antimicrobial properties by sequestering manganese and zinc in the presence of calcium, since these transition metals are essential to the survival of micro-organisms thus considered a part of the innate immune system (Clark et al. 2016; Hood and Skaar 2013).
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