The possible role of serum soluble Endoglin level in the diagnosis of hepatocellular carcinoma in patients with liver cirrhosis

Introduction: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with a high rate of morbidity and mortality. Endoglin (CD105) is an accessory receptor for transforming growth factor beta (TGF-?) and its expression is up regulated in actively proliferating endothelial cells. Endoglin has been suggested to play an important role in tumor-related angiogenesis and neovascularization. Aim of work: To evaluate the diagnostic value of circulating serum soluble endoglin in patients with liver cirrhosis with and without HCC and to compare it with other known diagnostic markers of HCC. Subjects and Methods: The study included, 15 healthy subjects served as control group (group I), 25 patients with liver cirrhosis without HCC (group II) and 25 patients with liver cirrhosis with HCC (group III). All subjects were subjected to thorough history and clinical examination, abdominal ultrasound and laboratory investigations including ; Liver and kidney function tests, complete blood picture in addition to measurement of serum ?-fetoprotein (AFP) and the serum soluble endoglin level. Results: The serum levels of soluble endoglin and AFP were significantly increased in hepatic cirrhosis with HCC patients as compared to those without HCC and controls subjects (p<0.001). In addition, there was significant increase of serum levels soluble endoglin in liver cirrhosis without HCC as compared to control subjects while there was no significant difference in AFP levels in the previous two groups. Soluble endoglin levels were significantly positively correlated with ALT and Child Pugh’s classes while AFP was significantly positively correlated with ALT only in liver cirrhosis without HCC. The serum levels of soluble endoglin and AFP were significantly positively correlated with ALT and TNM stages in liver cirrhosis with HCC. At a cut off value of 6.9 ng/ml, endoglin had a sensitivity of (72%) and specificity of (80 %) for diagnosis of HCC. While, AFP gave sensitivity of (68%) and specificity of (64%) at a cut off level of 18 ng/ml. The combined endoglin and AFP improve the sensitivity and specificity to (89%) and (85 %) respectively. Conclusions: Serum endoglin is highly sensitive and specific for detecting HCC specially if combined with AFP. Therefore, it may play an important role in early diagnosis of HCC.