EMAN RESEARCH PUBLISHING | <p>Diagnostic Efficacy of Tumor Markers AFP, CA19-9, and CEA in Hepatocellular Carcinoma Patients</p>
Inflammation Cancer Angiogenesis Biology and Therapeutics | Impact 0.1 (CiteScore) | Online ISSN  2207-872X
RESEARCH ARTICLE   (Open Access)

Diagnostic Efficacy of Tumor Markers AFP, CA19-9, and CEA in Hepatocellular Carcinoma Patients

Tufael 1*, Auditi Kar 2, Md Haroon Or Rashid 3, Atiqur Rahman Sunny 4*, António Raposo 5, Md. Saidul Islam 6, Md. Anower Hussain 7, Mohammad Anowar Hussen 8, Heesup Han 9, Henrique Douglas Melo Coutinho 10, Md. Sefaut Ullah 11, Md. Mizanur Rahman12

+ Author Affiliations

Journal of Angiotherapy 8(4) 1-10 https://doi.org/10.25163/angiotherapy.849513

Submitted: 05 February 2024  Revised: 30 March 2024  Published: 18 April 2024 

Abstract

Background: Current diagnostic methods, including tumor markers such as alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA), have limitations in sensitivity and specificity, particularly in differentiating Hepatocellular carcinoma (HCC) from chronic liver diseases. This study investigated the diagnostic efficacy of these markers, individually and in combination, using chemiluminescence assay (CLIA) in patients with and without HCC. Methods: A cross-sectional study design was employed, analyzing data from 800 patients at Ibn Sina Diagnostic and Imaging Center in Dhaka. Tumor marker levels were assessed using CLIA kits, and associations with HCC diagnosis, tumor differentiation, occupation, age, and tumor size were examined. Results: Descriptive statistics revealed higher tumor marker levels in poorly differentiated tumors compared to well-differentiated ones and controls. The combination of AFP, CA19-9, and CEA showed superior diagnostic accuracy for HCC, with a sensitivity of 86.5% and specificity of 92.3%. Occupation and age were found to correlate with tumor marker levels and HCC risk, with certain occupations and older age associated with larger tumor sizes. Regression analysis confirmed the associations between tumor markers and HCC. Conclusions: The study demonstrated the potential of AFP, CA19-9, and CEA as a panel of tumor markers for HCC detection and monitoring. CLIA emerged as a reliable diagnostic tool, offering high specificity and accuracy. Occupational factors and age were identified as relevant considerations in HCC risk assessment.

Keywords: Hepatocellular carcinoma; Tumor markers; Chemiluminescence immunoassay; Occupational exposure; Early diagnosis

References

Alam, K., Chowdhury, M. Z. A., Jahan, N., Rahman, K., Chowdhury, R., Mia, M. T., & Mithun, M. H. (2023). Relationship between Brand Awareness and Customer Loyalty in Bangladesh: A Case Study of Fish Feed Company. Journal of Knowledge Learning and Science Technology ISSN: 2959-6386 (online), 2(3), 212-222.

Allahverdi, N., Yassin, M., & Ibrahim, M. (2021). Environmental factors, lifestyle risk factors, and host characteristics associated with Philadelphia negative myeloproliferative neoplasm: a systematic review. Cancer Control, 28, 10732748211046802.

AlSalloom, A. A. M. (2016). An update of biochemical markers of hepatocellular carcinoma. International journal of health sciences, 10(1), 121.

Bari, K. F., Salam, M. T., Hasan, S. E., & Sunny, A. R. (2023). Serum zinc and calcium level in patients with psoriasis. Journal of Knowledge Learning and Science Technology ISSN: 2959-6386 (online), 2(3), 7-14.

Barrios, C. H. (2022). Global challenges in breast cancer detection and treatment. The Breast, 62, S3-S6.

Bertino, G., Ardiri, A., Malaguarnera, M., Malaguarnera, G., Bertino, N., & Calvagno, G. S. (2012, August). Hepatocellualar carcinoma serum markers. In Seminars in oncology (Vol. 39, No. 4, pp. 410-433). WB Saunders.

Chatsirisupachai, K., Lagger, C., & de Magalhães, J. P. (2022). Age-associated differences in the cancer molecular landscape. Trends in cancer, 8(11), 962-971.

de Oliveira, A. C., Simões, R. C., Lima, C. A., da Silva, F. M., Nunomura, S. M., Roque, R. A., ... & Nunomura, R. C. (2022). Essential oil of Piper purusanum C. DC (Piperaceae) and its main sesquiterpenes: Biodefensives against malaria and dengue vectors, without lethal effect on non-target aquatic fauna. Environmental Science and Pollution Research, 29(31), 47242-47253.

Fan, J. G., & Farrell, G. C. (2009). Epidemiology of non-alcoholic fatty liver disease in China. Journal of hepatology, 50(1), 204-210.

Ferdous, J., Sunny, A. R., Khan, R. S., Rahman, K., Chowdhury, R., Mia, M. T., ... & Mithun, M. H. (2023). Impact of Varying Synthetic Hormone on Mystus cavasius (Hamilton):: Fertilization, Hatching, and Survival Rates. Journal of Knowledge Learning and Science Technology ISSN: 2959-6386 (online), 2(3), 88-105.

Galle, P. R., Foerster, F., Kudo, M., Chan, S. L., Llovet, J. M., Qin, S., ... & Zhu, A. X. (2019). Biology and significance of alpha-fetoprotein in hepatocellular carcinoma. Liver international, 39(12), 2214-2229.

Hadi, H., Wan Shuaib, W. M. A., Raja Ali, R. A., & Othman, H. (2022). Utility of PIVKA-II and AFP in Differentiating Hepatocellular Carcinoma from Non-malignant High-risk patients. Medicina, 58(8), 1015.

Hasan, M. R., Hossain, M. M., Islam, M. S., Sunny, A. R., Ferdous, J., Chowdhury, M. Z. A., ... & Sultana, A. (2023). Seasonal variation of quality and the total viable count of lean and fatty fish. Egyptian Journal of Aquatic Biology & Fisheries, 27(5). DOI: 10.21608/EJABF.2023.324732

He, C. Z., Zhang, K. H., Li, Q., Liu, X. H., Hong, Y., & Lv, N. H. (2013). Combined use of AFP, CEA, CA125 and CAl9-9 improves the sensitivity for the diagnosis of gastric cancer. BMC gastroenterology, 13, 1-5.

Herszenyi, L., & Tulassay, Z. (2010). Epidemiology of gastrointestinal and liver tumors. European Review for Medical & Pharmacological Sciences, 14(4).

Hossain Ifty, S.M., Ashakin, M.R., Hossain, B., Afrin, S., Sattar, A., Chowdhury, R., Tusher, M.I., Bhowmik, P.K., Mia, M.T., Islam, T., Tufael, M. & Sunny, A.R.  (2023). IOT-Based Smart Agriculture in Bangladesh: An Overview. Applied Agriculture Sciences, 1(1), 1-6. 9563, 10.25163/agriculture.119563

Huang, K., Dong, Z., Cai, H., Huang, M., Peng, Z., Xu, L., ... & Feng, S. T. (2019). Imaging biomarkers for well and moderate hepatocellular carcinoma: preoperative magnetic resonance image and histopathological correlation. BMC cancer, 19, 1-10.

Kang, Y., Li, L., Chen, W., Zhang, F., Du, Y., & Wu, T. (2018). Rapid in situ SERS analysis of pesticide residues on plant surfaces based on micelle extraction of targets and stabilization of Ag nanoparticle aggregates. Food analytical methods, 11, 3161-3169.

Kew, M. C., Hodkinson, J., Paterson, A. C., & Song, E. (1982). Hepatitis-B virus infection in black children with hepatocellular carcinoma. Journal of Medical Virology, 9(3), 201-207.

Kwak, M. S., Chung, G. E., Yang, J. I., & Yim, J. Y. (2019). Long-term outcomes of HBsAg/anti-HBs double-positive versus HBsAg single-positive patients with chronic hepatitis B. Scientific Reports, 9(1), 19417.

Liu, A., Galoosian, A., Kaswala, D., Li, A. A., Gadiparthi, C., Cholankeril, G., ... & Ahmed, A. (2018). Nonalcoholic fatty liver disease: epidemiology, liver transplantation trends and outcomes, and risk of recurrent disease in the graft. Journal of Clinical and Translational Hepatology, 6(4), 420.

Loosen, S. H., Roderburg, C., Kauertz, K. L., Koch, A., Vucur, M., Schneider, A. T., ... & Luedde, T. (2017). CEA but not CA19-9 is an independent prognostic factor in patients undergoing resection of cholangiocarcinoma. Scientific reports, 7(1), 16975.

McGlynn, K. A., Petrick, J. L., & London, W. T. (2015). Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clinics in liver disease, 19(2), 223-238.

Mirambo, M. M., Mkumbo, E., Selega, H., Msemwa, B., Mushi, M. F., Silago, V., ... & Kasang, C. (2020). Hepatitis B virus infections among health professional students in Mwanza city, Tanzania in 2016. Archives of Public Health, 78, 1-5.

Motlagh, A., Elmi, F., Yamrali, M., Ranjbar, M., Azmin, M., Moshiri, F., ... & Malekzadeh, R. (2021). Routine COVID-19 testing may not be necessary for most cancer patients. Scientific Reports, 11(1), 23294.

Nordenstedt, H., White, D. L., & El-Serag, H. B. (2010). The changing pattern of epidemiology in hepatocellular carcinoma. Digestive and Liver Disease, 42, S206-S214.

Ogunwobi, O. O., Harricharran, T., Huaman, J., Galuza, A., Odumuwagun, O., Tan, Y., ... & Nguyen, M. T. (2019). Mechanisms of hepatocellular carcinoma progression. World journal of gastroenterology, 25(19), 2279.

Parra, N. S., Ross, H. M., Khan, A., Wu, M., Goldberg, R., Shah, L., ... & Halegoua-DeMarzio, D. (2023). Advancements in the diagnosis of hepatocellular carcinoma. International Journal of Translational Medicine, 3(1), 51-65.

Ringelhan, M., Pfister, D., O’Connor, T., Pikarsky, E., & Heikenwalder, M. (2018). The immunology of hepatocellular carcinoma. Nature immunology, 19(3), 222-232.

Sazzad, S. A., Billah, M., Sunny, A. R., Anowar, S., Pavel, J. H., Rakhi, M. S., ... & Al-Mamun, M. A. (2023). Sketching Livelihoods and Coping Strategies of Climate Vulnerable Fishers. Egyptian Journal of Aquatic Biology & Fisheries, 27(4).

Singal, A. K., Singh, A., Jaganmohan, S., Guturu, P., Mummadi, R., Kuo, Y. F., & Sood, G. K. (2010). Antiviral therapy reduces risk of hepatocellular carcinoma in patients with hepatitis C virus–related cirrhosis. Clinical Gastroenterology and Hepatology, 8(2), 192-199.

Sinha, S. R., Prakash, P., Singh, R. K., & Sinha, D. K. (2022). Assessment of tumor markers CA 19-9, CEA, CA 125, and CA 242 for the early diagnosis and prognosis prediction of gallbladder cancer. World Journal of Gastrointestinal Surgery, 14(11), 1272.

Song, M. J., Jung, C. K., Park, C. H., Hur, W., Choi, J. E., Bae, S. H., ... & Yoon, S. K. (2011). RPL36 as a prognostic marker in hepatocellular carcinoma. Pathology international, 61(11), 638-644.

Song, Q., Hawkins, G. A., Wudel, L., Chou, P. C., Forbes, E., Pullikuth, A. K., ... & Zhang, W. (2019). Dissecting intratumoral myeloid cell plasticity by single cell RNA-seq. Cancer medicine, 8(6), 3072-3085.

Tufael, Hasan, S. E., Jubayer, A., Akter, K., Akter, A., Akter, F., Al Shiam, S. A., & Sunny, A. R. (2023). Effects of Nigella Sativa and Syzygium Cumini Seed Extracts on Blood Glucose Levels in Swiss Albino Mice. Journal of Knowledge Learning and Science Technology ISSN: 2959-6386 (online), 2(3), 53-62.

Wang, X., Wang, N., Zhong, L., Wang, S., Zheng, Y., Yang, B., ... & Wang, Z. (2020). Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Molecular psychiatry, 25(12), 3186-3197.

Williams, R. (2006). Global challenges in liver disease. Hepatology, 44(3), 521-526.

Zhang, J., Chen, G., Zhang, P., Zhang, J., Li, X., Gan, D. N., ... & Ye, Y. A. (2020). The threshold of alpha-fetoprotein (AFP) for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis. PLoS One, 15(2), e0228857.

Zhou, L., Liu, J., & Luo, F. (2006). Serum tumor markers for detection of hepatocellular carcinoma. World journal of gastroenterology: WJG, 12(8), 1175.

Zhu, A. X., Finn, R. S., Edeline, J., Cattan, S., Ogasawara, S., Palmer, D., ... & Yamashita, T. (2018). Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. The Lancet Oncology, 19(7), 940-952.

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