Case Control Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 28, 2017; 9(9): 469-476
Published online Mar 28, 2017. doi: 10.4254/wjh.v9.i9.469
Annexin A2 as a biomarker for hepatocellular carcinoma in Egyptian patients
Mohamed K Shaker, Hanzada I Abdel Fattah, Ghada S Sabbour, Iman F Montasser, Sara M Abdelhakam, Eman El Hadidy, Rehab Yousry, Ahmed K El Dorry
Mohamed K Shaker, Iman F Montasser, Sara M Abdelhakam, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Hanzada I Abdel Fattah, Ghada S Sabbour, Eman El Hadidy, Rehab Yousry, Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Ahmed K El Dorry, Department of Radiodiagnosis and Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Author contributions: Shaker MK and El Dorry AK contributed equally to this work; Shaker MK, Abdel Fattah HI, Sabbour GS and El Dorry AK designed the research; Shaker MK, Montasser IF, Abdelhakam SM, El Hadidy E, Yousry R and El Dorry AK performed the research; Abdel Fattah HI, Sabbour GS, El Hadidy E and Yousry R contributed analytic tools; Shaker MK, El Dorry AK, Montasser IF and Abdelhakam SM analyzed the data; Montasser IF and Abdelhakam SM wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Research Ethics Committee of the Faculty of Medicine, Ain Shams University.
Clinical trial registration statement: This study is registered at (https://clinicaltrials.gov/ct2/show/NCT02541149), the registration identification number is (NCT02541149).
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interest or financial disclosures.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at saratropical@yahoo.com. The participants gave informed consent for the data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara M Abdelhakam, MD, Assistant Professor of Tropical Medicine, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Khalifa El-Maamon Street, Abbassia, Cairo 11341, Egypt. saratropical@yahoo.com
Telephone: +20-22-1001601548 Fax: +20-22-2598751
Received: September 29, 2016
Peer-review started: September 30, 2016
First decision: December 27, 2016
Revised: January 6, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: March 28, 2017
Processing time: 175 Days and 16.6 Hours
Abstract
AIM

To investigate the clinical utility of serum annexin A2 (ANXA2) as a diagnostic marker for early hepatocellular carcinoma (HCC).

METHODS

This study was performed in HCC Clinic of Ain Shams University Hospitals, Cairo, Egypt and included: Group 1: Fifty patients with early stage HCC (Barcelona Clinic Liver Cancer stage A); Group 2: Twenty five patients with chronic liver disease; and Control Group: Fifteen healthy, age- and sex-matched subjects who were seronegative for viral hepatitis markers. The following laboratory investigations were done: Viral hepatitis markers [hepatitis B surface antigen and hepatitis C virus (HCV) antibodies], HCV RNA in HCV antibody-positive patients, serum alpha fetoprotein (AFP), and serum ANXA2 levels.

RESULTS

In this study, 88% of HCC patients (n = 44) were HCV-positive, while HBV infection represented only 8% of all HCC patients (n = 4); and two patients were negative for both viral markers. A highly significant difference was found between patients with HCC and chronic liver disease as well as controls with regard to serum ANXA2 levels (130, IQR 15-240; 15, IQR 15-17; and 17, IQR 15-30 ng/mL, respectively). The area under the curve of ANXA2 was 0.865; the cut-off value was established to be 18 ng/mL with a diagnostic sensitivity of 74% and a specificity of 88%, while the sensitivity and specificity of AFP at the cut-off value of 200 ng/dL were 20% and 100%, respectively.

CONCLUSION

Serum ANXA2 may serve as a biomarker for the early detection of HCC.

Keywords: Hepatocellular carcinoma; Hepatitis C virus; Annexin A2; Alpha-fetoprotein; Tumor markers

Core tip: Thirty percent of hepatocellular carcinoma (HCC) patients present with normal serum alpha fetoprotein, which highlights the need for new biomarkers for HCC. In the present study, a highly significant difference was observed among patients with HCC and chronic liver disease as well as controls with regard to serum annexin A2 (ANXA2) levels (130, IQR 15-240; 15, IQR 15-17; and 17, IQR 15-30 ng/mL, respectively). The area under the curve of ANXA2 was 0.865; the cut-off value was 18 ng/mL with a diagnostic sensitivity of 74% and specificity of 88%. Thus, ANXA2 may serve as a useful biomarker for the early detection of HCC.