title: Chromogranin A levels in chronic liver disease and hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is the relevant cause of death in patients with compensated cirrhosis. Alpha-fetoprotein (AFP) is used for screening HCC, with limited success.
  
  
  OBJECTIVE
  We evaluated plasma chromogranin A (CgA) as a marker of HCC.
  
  
  METHODS
  CgA plasma levels and AFP serum levels were prospectively measured in 30 patients with HCC, 14 with cirrhosis, 79 with chronic hepatitis and 65 controls.
  
  
  METHODS
  CgA was measured with an enzyme-linked immunosorbent assay (DAKO A/S Glostrup, Denmark). AFP was measured by electrochemiluminoimmunoassay (Elecsys, Roche S.p.A., Italy).
  
  
  RESULTS
  CgA levels were significantly higher in the three groups of patients than in controls and in patients with HCC they were significantly higher than in chronic hepatitis patients [median 44.5 (interquartile range 21-145.9)U/L vs. 15.3 (10.9-29.25)U/L, p<0.001]. AFP values were above the upper reference limit in 75% of patients with HCC, 50% of cirrhotic patients and 11% of chronic hepatitis patients (p<0.005). CgA values significantly correlated with AFP levels (r(s)=0.42, p<0.0001). The overall diagnostic accuracy of CgA was 75% (CI 66-82), with a sensitivity of 70% (CI 50.6-85.2) and a specificity of 67% (CI 55.9-76.3).
  
  
  CONCLUSIONS
  Despite the evidence of higher CgA levels in patients with HCC, this test has low-diagnostic accuracy. Its pathophysiological meaning remains unknown, even if it could suggest an endocrine phenotype of HCC.
authors.affiliation: Gastroenterology Unit II, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy. sara.massironi@libero.it
authors.forename: S
authors.initials: S
authors.lastname: Massironi
authors.forename: M
authors.initials: M
authors.lastname: Fraquelli
authors.forename: S
authors.initials: S
authors.lastname: Paggi
authors.forename: A
authors.initials: A
authors.lastname: Sangiovanni
authors.forename: D
authors.initials: D
authors.lastname: Conte
authors.forename: V
authors.initials: V
authors.lastname: Sciola
authors.forename: C
authors.initials: C
authors.lastname: Ciafardini
authors.forename: M
authors.initials: M
authors.lastname: Colombo
authors.forename: M
authors.initials: M
authors.lastname: Peracchi