Serum clusterin as a marker for diagnosing hepatocellular carcinoma

Abstract

Background: Approximately 80% of patients with hepatocellular carcinoma (HCC) are
untreatable because of advanced tumor stages at presentation. Therefore, finding newer markers for screening and diagnosing HCC is of utmost importance. Clusterin (CLU) is a 449 amino acid, heterodimeric glycoprotein with a plausible role in the regeneration, migration, and anti-apoptosis of tumor cells. It has been implicated in many malignancies such as prostate and pancreatic adenocarcinomas, but its role in HCC is not well defined.
Objective: We aimed to evaluate the diagnostic performance of serum CLU level in diagnosing HCC on top of hepatitis C virus-related liver cirrhosis, and comparing it to that of alpha fetoprotein (AFP).
Methods: Twenty cases of apparently healthy subjects, 27 cases of hepatitis C virus-related liver cirrhosis (CHC cases), and 44 HCC cases on top of hepatitis C virus-related liver cirrhosis were included in this study. Serum CLU concentration was determined using a quantitative sandwich enzyme immunoassay technique.
Results: Serum clusterin level showed a significant increase in the HCC group compared to the control group (151.96 ± 32.74 vs. 111.40 ±27.46) and to the CHC group (151.96 ± 32.74 vs. 89.12 ±31.62), while a significant decrease in serum clusterin level was found in the CHC group compared to the control group (89.12± 31.62 vs. 111.40± 27.46). Based on receiver operator characteristic curve analysis, serum AFP still surpassed serum CLU in diagnostic sensitivity (77.3% vs. 70.5%), specificity (100% vs. 90%), and positive and negative predictive values (100% vs. 86.1% and 83.3% vs. 77.6% respectively). The use of a combined parallel approach improved the diagnostic sensitivity (95.5%) and negative predictive value (95.7%) over the single use of AFP.
Conclusions: Although the diagnostic performance of serum AFP outperformed that of serum CLU, their combined parallel approach improved the sensitivity which is required in screening high risk populations such as CHC patients. 

KEYWORDS Clusterin; Alpha fetoprotein; Tumor marker; Hepatitis C virus related liver cirrhosis; Hepatocellular carcinoma