Serum insulin-like growth factor-II as a serologic marker of small hepatocellular carcinoma.
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.
Tsai
J F
JF
Department of Internal Medicine, Kaohsiung Medical University College of Medicine, Taiwan. jftsai@cc.kmu.edu.tw
Jeng
J E
JE
Chuang
L Y
LY
You
H L
HL
Wang
L Y
LY
Hsieh
M Y
MY
Chen
S C
SC
Chuang
W L
WL
Lin
Z Y
ZY
Yu
M L
ML
Dai
C Y
CY
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
D014408:Biomarkers, Tumor; D007335:Insulin-Like Growth Factor II