Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1463
Peer-review started: December 16, 2019
First decision: February 18, 2020
Revised: March 6, 2020
Accepted: March 19, 2020
Article in press: March 19, 2020
Published online: April 7, 2020
The prognosis of hepatocellular carcinoma (HCC) patients remains poor despite advances in treatment modalities and diagnosis. The early detection of HCC allows patients to receive curative treatment and achieve long-term survival. It is important to identify useful markers for the early detection of HCC in patients.
Preneoplastic antigen (PNA), originally reported in a rat carcinogenesis model, is increased in the tissues and serum of HCC patients. However, the diagnostic value of PNA for discriminating HCC remains to be determined.
The objectives of this study are to determine the diagnostic value of PNA for discriminating HCC and to characterize PNA-positive HCC.
Patients with hepatitis C virus-related hepatic disorders were prospectively enrolled in this study, which included patients with hepatitis, with cirrhosis, and with HCC. A novel enzyme-linked immunosorbent assay was developed to measure serum PNA concentrations in patients.
Compared with control and non-HCC patients, PNA was increased in HCC. The sensitivity of PNA was similar to the HCC markers des-γ-carboxy-prothrombin (DCP) and αα-fetoprotein (AFP), but the specificity of PNA was lower. There was no correlation between PNA and AFP and a significant but weak correlation between PNA and DCP in HCC patients. Importantly, the correlations with biochemical markers indicated that GTP was highly correlated with PNA, but not with AFP or DCP, and that it was significantly higher in PNA-high patients than in PNA-low patients with hepatitis C virus-related HCC.
PNA may have the potential to diagnose a novel type of HCC in which GTP is positively expressed but AFP or DCP is weakly or negatively expressed.
Further studies are needed to determine the diagnostic value of PNA for HCC patients in comparison with other HCC markers and to determine its potential for the detection of HCC nodules in the early stage. PNA-positive HCC may have an aggressive phenotype with a higher risk for disease progression and a poor prognosis. The prognostic value of PNA for survival will be determined in a follow-up evaluation of the patients enrolled in this study.