Assessment of high-sensitivity C-reactive protein tests for the diagnosis of hepatocellular carcinoma in patients with hepatitis B-associated liver cirrhosis

Ma,Li‑Na; Liu,Xiao‑Yan; Lu,Zhen‑Hui; Wu,Li‑Gang; Tang,Yuan‑Yuan; Luo,Xia; Hu,Yan‑Chao; Yan,Ting‑Ting; Wang,Qi; Ding,Xiang‑Chun; Xie,Yan

doi:10.3892/ol.2017.5890

Assessment of high-sensitivity C-reactive protein tests for the diagnosis of hepatocellular carcinoma in patients with hepatitis B-associated liver cirrhosis

Authors:
- Li‑Na Ma
- Xiao‑Yan Liu
- Zhen‑Hui Lu
- Li‑Gang Wu
- Yuan‑Yuan Tang
- Xia Luo
- Yan‑Chao Hu
- Ting‑Ting Yan
- Qi Wang
- Xiang‑Chun Ding
- Yan Xie
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Affiliations: Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China, Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China, Department of Oncological Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China, Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China, Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
Published online on: March 22, 2017 https://doi.org/10.3892/ol.2017.5890
Pages: 3457-3464
Copyright: © Ma et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide, with high morbidity and mortality. Chronic infection with hepatitis B virus (HBV) is a major risk factor for the development of hepatocellular carcinoma and the majority (~80%) of hepatocellular carcinoma patients in China exhibit co‑morbidity with HBV‑associated liver cirrhosis. The goal of reliable early diagnostic and prognostic techniques for HBV‑associated HCC remains unrealized. The aim of the present study was to explore the efficacy of serum high‑sensitivity C‑reactive protein (hs‑CRP) tests in the early diagnosis of HCC in patients with HBV‑associated liver cirrhosis. A cohort of 493 patients with HBV‑associated liver disease was divided into three groups: Chronic HBV (CHB) group; liver cirrhosis without HCC (LC) group; and liver cirrhosis with HCC (HCC) group. A further 47 healthy individuals comprised the healthy control (CN) group. Comparative analyses of clinical symptoms, histopathology, ultrasound imagery, computed tomography, magnetic resonance imaging, biochemistry [α-fetoprotein (AFP) and liver function enzymes], and hs‑CRP tests were conducted across these four groups. Immunohistochemical analysis showed that CRP is strongly expressed in HCC tumor tissue, but is not expressed elsewhere. Analyses of the correlations between serum hs‑CRP levels and HCC clinical parameters indicated that there was no correlation between serum hs‑CRP levels, tumor Edmondson grade, tumor‑node‑metastasis stage and AFP status. Serum hs-CRP and AFP levels were found to be significantly elevated in the HCC group compared to those in the LC, CHB and CN groups (P<0.01). Receiver operator characteristic analysis showed that measurement of serum hs‑CRP could differentiate HCC from HBV-associated liver cirrhosis, as well as increase the accuracy of HCC diagnoses. Additionally, measurement of hs-CRP and AFP together improved diagnostic accuracy for HCC compared with either test alone. Serum hs‑CRP could have potential as an effective diagnostic tool to complement AFP in diagnosing HCC and improving the identification of AFP-negative HCC in patients with HBV‑associated liver cirrhosis. The present findings may facilitate the earlier diagnosis of hepatocellular carcinoma, permitting more effective treatment and a broader spectrum of treatment modalities for patients with advanced hepatic disease.

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