Serum Levels of Soluble Fas and Soluble Fas Ligand as Markers for Hepatocellular Carcinoma in Hepatitis C Virus Patients

Background: Hepatocellular carcinoma (HCC) ranks fifth among the most prevalent cancers worldwide. In Egypt, the incidence of HCC had been doubling due to hepatitis C viral (HCV) infection. New serum tumor markers are required for diagnosis of HCC instead of alpha-fetoprotein (the most widely used marker) due to its poor diagnostic accuracy. The Fas receptor/ ligand system, including soluble forms, is the most im¬portant apoptosis initiator in the liver. Dysregula¬tion of this pathway may contribute to abnormal cell proliferation. Aim: To assess the diagnostic accuracy of serum soluble Fas (sFas), and soluble Fas Ligand (sFasL) levels as biomarkers for diagnosis of HCC. Subjects and Methods: 60 adult patients were selected for this study. They were categorized into: (Group II) which included 30 patients with cirrhosis with hepatitis C virus and (Group III) which included 30 patients with newly diagnosed HCC group on top cirrhosis and hepatitis C virus. 20 healthy subjects, age and sex-matched, were enrolled as controls. Routine tests for liver cirrhosis & HCC were done. Serum sFas, and sFasL levels were measured using enzyme-linked immunosorbent assay. Results: Serum sFas, and sFasL levels were significantly elevated in HCC group when compared with other 2 groups. Insignificant difference between Okuda & BCLC stages as regard AFP levels but there were significant difference between Okuda & BCLC stages as regard serum sFas, and sFasL levels, as the levels of these markers were became higher as the tumor stage became more advanced. Significant positive correlations were found between sFas, and sFasL in one hand, and total bilirubin, direct bilirubin, prothrombin time and tumor size on the other hand. Significant positive correlations were found between sFas, and sFasL with each other. At cut off level ? 1770 pg/ml, serum sFas had 76.67% sensitivity, 83.33 % specificity for diagnosis of HCC. Regarding serum sFasL level for diagnosis of HCC, it had 86.67% sensitivity, 83.33% specificity at cut off level ? 1310 pg/ml. Conclusions: The results of the present study clearly demonstrate that serum sFas, and sFasL had a better sensitivity and specificity than AFP in differentiating patients with HCC from those with cirrhosis. sFas, and sFasL could be used as reliable biomarkers for HCC in HCV patients.