title: Serum insulin-like growth factor-II as a serologic marker of small hepatocellular carcinoma.
abstract: OBJECTIVE
  Alpha-fetoprotein (AFP) is not a useful tumor marker for diagnosis of small hepatocellular carcinoma (HCC). There is over-expression of insulin-like growth factor (IGF)-II in HCC tissue. This study investigates the diagnostic application of IGF-II in small HCC.
  
  
  METHODS
  Serum levels of IGF-II and AFP were determined in 41 patients with small cirrhotic HCC (< or = 3 cm), 41 sex- and age-matched patients with cirrhosis alone (LC), and 41 healthy adults. The optimal cut-off values for diagnosing HCC were determined with receiver operating characteristics (ROC) curve.
  
  
  RESULTS
  Both IGF-II and AFP levels in HCC were higher than those in LC patients or controls (each p = 0.0001). The IGF-II levels in LC patients were lower than those in controls (p = 0.001). In HCC patients, multivariate analysis indicated that that both IGF-II (odds ratio, 4.54; 95% confidence interval, 2.15-9.55; p = 0.0001) and AFP (odds ratio, 1.05; 95% confidence interval, 1.01-1.08; p = 0.003) were found to be associated with an increased risk of presence of HCC. The optimal cut-off values of IGF-II (4.1 mg/g prealbumin) and AFP (50 ng/ml) were determined with ROC curves. The sensitivity, specificity, and diagnostic accuracy values for IGF-II were 63%, 90%, and 70%, respectively. Those for AFP were 44%, 95%, and 70%, respectively. Determination of both markers in parallel significantly increase the diagnostic accuracy (88%) and sensitivity (80%), with a high specificity (90%).
  
  
  CONCLUSIONS
  Serum IGF-II level can be used as an independent serologic marker or a complementary tumor marker to AFP for diagnosis of small HCC.
authors.affiliation: Department of Internal Medicine, Kaohsiung Medical University College of Medicine, Taiwan. jftsai@cc.kmu.edu.tw
authors.forename: J F
authors.initials: JF
authors.lastname: Tsai
authors.forename: J E
authors.initials: JE
authors.lastname: Jeng
authors.forename: L Y
authors.initials: LY
authors.lastname: Chuang
authors.forename: H L
authors.initials: HL
authors.lastname: You
authors.forename: L Y
authors.initials: LY
authors.lastname: Wang
authors.forename: M Y
authors.initials: MY
authors.lastname: Hsieh
authors.forename: S C
authors.initials: SC
authors.lastname: Chen
authors.forename: W L
authors.initials: WL
authors.lastname: Chuang
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Lin
authors.forename: M L
authors.initials: ML
authors.lastname: Yu
authors.forename: C Y
authors.initials: CY
authors.lastname: Dai
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007335:Insulin-Like Growth Factor II / Q000032:analysis*; D008103:Liver Cirrhosis / Q000097:blood* / Q000401:mortality / Q000473:pathology; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D007335:Insulin-Like Growth Factor II