Serum Neopterin as a Marker for Screening of Hepatocellular Carcinoma

Abstract As Screening markers for hepatocellular Carcinoma (HCC), alpha-fetoprotein (AFP) and protein induced by an absence of vitamin K or antagonist-II (PIVKA-II) are widely used, but the sensitivity and specificity are not satisfactory enough. Neopterin is a biological marker for increased cell-mediated immunity, but has not been fully studied on HCC. To assess the clinical significance of serum neopterin as a screening marker for HCC, fifty-six HCC patients with liver cirrhosis (LC) and thirty-two LC patients without HCC as controls were studied. Serum neopterin level (n mol/L) was determined by immunoenzymatic assay. The sensitivity and specificity were analyzed by using ROC analysis. The mean level oi neopterin in HCC was significantly higher than that in LC (20.4 YS. 7.7 nmol/L, P<0.001). There was no significant relationship among serum AFP, PIVKA-II, and neopterin in HCC patients. When the cut-off value was set at 12 n mol/L, the sensitivity and specificity of neopterin was 88% and 73%, respectively. In patients with early HCC (<3cm), the detection rate of AFP, PIVKA-II, and neopterin was 35%, 35%, and 70 %, respectively. When all three markers were used, 95% of all HCC patients and 90% of early HCC patients could be detected. The detection rate of neopterin was not affected by ALT level, PLT count, liver function, angiographic pattern, histology, TNM stage, and type of tumor. These findings suggests that serum neopterin can be useful as a Screening marker for HCC and makes it possible to detect HCC at its earlier stage when used in combination with AFP or PIVKA-II.

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