Serum Level of Tumor Necrosis Factor Alpha as Marker for Hepatitis C Virus- Related Hepatocellular Carcinoma

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. Chronic inflammation is thought to be a cause of cancer. Tumor necrosis factor-alpha (TNF-?) is an important inducer of the inflammatory response and is regarded as tumor promoter. Aim: To assess the diagnostic accuracy of serum tumor necrosis factor alpha (TNF-?) level as biomarker 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 TNF-? level was measured using enzyme-linked immunosorbent assay. Results: Serum TNF-? was 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 TNF-? level, as the level of these marker was became higher as the tumor stage became more advanced. Significant positive correlations were found between TNF-? in one hand, and total bilirubin, direct bilirubin, prothrombin time and tumor size on the other hand. At cut off level ? 21.5 pg/ml, serum TNF-? had 86.67% sensitivity, 73.33 % specificity for diagnosis of HCC. Conclusions: The results of the present study clearly demonstrate that serum TNF-? had a better sensitivity and specificity than AFP in differentiating patients with HCC from those with cirrhosis. TNF-? could be used as reliable biomarker for HCC in HCV patients.