Background: Transforming growth factor alpha (TGF alpha) is alleged to play a role in malignant progression as well as normal cell growth in an autocrine manner and its serum levels have been reported to increase during this progression. Most hepatocellular carcinomas (HCC) develop in cirrhotic livers in which hepatocyte necrosis and regeneration prevail. The significance of serum TGF alpha levels in the diagnosis of HCC complicating cirrhosis should be clarified.
Methods: One hundred twenty-four patients with cirrhosis were studied, 80 with HCC (HCC) patients and 44 without (LC) patients. There was no difference in clinical features between the two groups. One hundred eighty-two healthy adults were also studied as controls. Serum TGF alpha levels were measured by enzyme-linked immunosorbent diffusion assay (ELISA).
Results: Serum TGF alpha levels were significantly higher in HCC patients than in healthy adults or LC patients (mean +/- SD: 45 +/- 40 vs. 21 +/- 15 or 25 +/- 19 pg/ml, respectively). In LC patients, serum TGF alpha levels were significantly correlated with serum albumin and total bilirubin levels (r = -0.44 and 0.32, respectively). When the cutoff level was defined as 25 pg/ml from receiver operating characteristic curve, sensitivity and specificity for the diagnosis of HCC in the presence of cirrhosis were 69% and 66%, respectively. Serum TGF alpha levels were decreased after successful treatment for HCC in 60% of the HCC patients. Serum TGF alpha levels showed no correlation with serum alpha-fetoprotein levels; the levels were greater than 25 pg/ml in 67% of the HCC patients whose serum alpha-fetoprotein levels were within 20 ng/ml.
Conclusion: Serum TGF alpha levels may provide useful information for the diagnosis of HCC developing in the presence of cirrhosis.