Risk of Early Hepatocellular Carcinoma Recurrence after Curative Ablation: Association with Cytokeratine 18

Introduction and aim: Evidence has now accrued that hepatocellular apoptosis plays a central role in chronic liver diseases and hepatocellular carcinoma (HCC). Cytokeratin 18 (CK18) fragments have been examined as potential tumor markers in many different types of epithelial cell carcinomas, including HCC. Therefore we evaluated the serum level of CK18 to predict early recurrence of HCC after curative local ablation and macroscopic vascular invasion. Methods: A case control study was done on 108 patients with HCC of various Barcelona Clinic Liver Cancer (BCLC) Staging underwent percutaneous local ablation and were followed up for local recurrence, compared to 110 Control subjects classified into 80 cirrhotic patients proved by liver biopsy and 30 healthy control subjects. Serum level of CK18-M30Apoptosense was analyzed in all subjects. Results: CK18 level was significantly elevated in HCC patients when compared to control groups (p< 0.001). There was no significant difference in the level of CK18 pre and post successful local ablation (percutaneous ethanol injection or radiofrequency ablation) (p= 0.15), whereas there was significant increase in basal CK18 level in patients with recurrent local lesion versus those with no recurrence (p< 0.001). Conclusion: CK18 M30 could be used as a prognostic marker for prediction of early local recurrence of HCC, but unfortunately, their was no value in detection of successful ablation. In addition to older age- more than 60 years- and larger tumor diameter-3 to 5 cm-were two independent risk variables.