Combined Biomarkers for Early Diagnosis of Hepatocellular Carcinoma

Tufael ¹, Md Mostafizur Rahman ², Vijay Jagdish Upadhye ³*, Md Faruk Hossain ², Nasir Uddin ⁴

This retrospective study assessed AFP, CEA, and CA19-9 efficacy, highlighting AFP's importance in early hepatocellular carcinoma detection.

Abstract

Objective: This retrospective study aimed to evaluate the efficacy of serum biomarkers, specifically alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and cancer antigen 19-9 (CA19-9), individually and in combination, for screening and diagnosing primary hepatic cancer (PHC) in asymptomatic patients. Methods: A retrospective cross-sectional analysis of 1369 patients from October 2022 to November 2023 was analyzed. Preoperative serum levels of AFP, CEA, and CA19-9 were measured and correlated with histological findings. Sensitivity, specificity, and predictive values were calculated for each biomarker alone and in combination. Results: Patients with PHC exhibited significantly elevated levels of AFP, CEA, and CA19-9 compared to those with liver cirrhosis and healthy controls (P < 0.03). AFP alone showed moderate sensitivity (64.6%) and high specificity (81.7%) for PHC diagnosis. However, combining AFP with CA19-9 and CEA achieved 100% specificity while drastically reducing sensitivity (2.4%). Histological evaluation revealed varying AFP levels across tumor differentiation grades. Conclusion: Despite the elevated levels of CEA and CA19-9 in PHC patients, combining these biomarkers with AFP did not significantly enhance diagnostic accuracy compared to AFP alone. The study suggests that AFP remains a valuable biomarker for screening and diagnosing hepatocellular carcinoma, but further investigations are warranted to explore additional biomarkers or complementary diagnostic modalities for improving early detection and management.

Keywords: Hepatocellular Carcinoma, Serum Biomarkers, Alpha-Fetoprotein, Carcinoembryonic Antigen, Cancer Antigen 19-9.

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