Tumor necrosis factor-alpha and alpha-fetoprotein as biomarkers for diagnosis and follow-up of hepatocellular carcinoma before and after interventional therapy

Abstract

Introduction

Up to 90% of the hepatocellular carcinoma (HCC) cases in Egypt were attributable to hepatitis C virus (HCV) infection. The absolute positive and negative markers for HCC are still deficient. Alpha-fetoprotein (AFP), the most widely used biomarker for early detection and clinical follow-up of patients with HCC, has a sensitivity and a specificity of 41–65% and 80–94%, respectively, even with low cutoff value at 20 ng/ ml. High plasma levels of tumor necrosis factor-alpha (TNF-α) are associated with some cancers, and it has an important central role in hepatocarcinogenesis and involved in cancer invasion with or without metastasis.

Aim

To evaluate the diagnostic accuracy of TNF-α versus AFP as biomarkers for detection of HCC on top of HCV-related cirrhosis and to assess treatment response by using TNF-α and AFP after locoregional intervention of HCC.

Patients and methods

A total of 27 normal control, 51 cirrhotic patients, and 69 cirrhotic patients with HCC were studied in two phases. Radiofrequency ablation and transarterial chemoembolization were done, and patients were followed up for response and tumor marker values.

Results

TNF-α in the diagnosis of Egyptian patients with HCC related to HCV cirrhosis had a sensitivity of 100% and a specificity of 94.1% at a cutoff value of more than or equal to 30 pg/ml. Moreover, more than or equal to 15.2% decrement is a good predictor of complete ablation versus partially or failed ablation with a sensitivity of 78.6%, a specificity of 83.3%, and overall accuracy of 80.77%.

Conclusion

Combined use of TNF-α in addition to AFP increases sensitivity and specificity for early diagnosis of HCC rather than the use of each tumor marker alone. Moreover, TNF-α could be a better noninvasive tumor marker than AFP for assessment of response after locoregional therapy of HCC.