Diagnostic Value of Systemic Cholesteryl Ester/Free Cholesterol Ratio in Hepatocellular Carcinoma

Anticancer Res. 2017 Jul;37(7):3527-3535. doi: 10.21873/anticanres.11721.


Background: Hepatocellular carcinoma (HCC) most commonly occurs in the setting of liver cirrhosis which is characterized by low serum lipids. We hypothesized that composition of lipoproteins and consequently lipid species ratios are mostly unchanged in patients with cirrhosis compared to controls. This approach may be appropriate to identify lipid ratios altered in HCC irrespective of liver dysfunction.

Patients and methods: Lipids were measured in serum of 21 patients with HCC, 41 patients with liver cirrhosis and 22 controls. Ratios of lipids known to be changed in HCC tissues were calculated.

Results: Ratios of polyunsaturated to mono-unsaturated lysophosphatidylcholine, ceramide/sphingomyelin and cholesteryl ester/free cholesterol were changed in HCC compared to both control cohorts. The latter was most suited to diagnosing HCC. Systemic ratios of these lipid classes were not associated with fibrosis, staging or grade in patients with HCC.

Conclusion: The cholesteryl ester/free cholesterol ratio is comparable in controls and patients with cirrhosis, but is specifically increased in patients with HCC.

Keywords: Phospholipids; cholesterol; hepatocellular carcinoma; liver cirrhosis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / metabolism*
  • Ceramides / metabolism
  • Cholesterol / metabolism*
  • Cholesterol Esters / metabolism*
  • Female
  • Humans
  • Lipids
  • Liver Cirrhosis / metabolism
  • Liver Neoplasms / metabolism*
  • Male
  • Middle Aged


  • Ceramides
  • Cholesterol Esters
  • Lipids
  • Cholesterol