title: Insulin-like growth factor-II is a useful marker to detect hepatocellular carcinoma?
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is a typical hypervascular tumor. The utility of serum alpha-fetoprotein (α-FP) in its detection is questionable. Over-expression and high circulating levels of insulin-like growth factor-II (IGF-II) were reported in tissue and in serum of patients with HCC. We investigated the diagnostic application of IGF-II in the diagnosis of HCC.
  
  
  METHODS
  Serum IGF-II and α-FP levels were measured in 178 patients (82 with HCC and 96 with liver cirrhosis) and in 30 healthy controls. Spearman test, non parametric combination test and confidence interval analysis were used for statistical evaluation of data.
  
  
  RESULTS
  The best cut-off values selected by ROC curves were 796 ng/ml for IGF-II and 132 ng/ml for α-FP. IGF-II mean values were higher in patients with HCC than in those with liver cirrhosis (LC) (p=0.0001) but lower in LC than in controls (p=0.0001). Serum IGF-II levels above cut-off were found in 22% of patients with HCC, in 9.3% of those with cirrhosis and in 20% of controls. α-FP serum levels >132 ng/ml were observed in 48% of HCC, in 3.1% of LC and in none of control group. By correlation study, serum IGF-II levels were significantly correlated with serum α-FP levels (r=0.427, p=0.0001) and with nodules' diameter (r=0.252, p=0.0130) but not with nodules' number (p>0.050). Finally, IGF-II showed lower sensitivity, specificity and predictive values than α-FP.
  
  
  CONCLUSIONS
  Circulating IGF-II is not a useful marker for HCC. Further researches are however needed to evaluate its diagnostic accuracy before and after nutritional adjustment.
authors.affiliation: Dipartimento di Medicina Interna, UOC di Medicina interna ad Indirizzo Gastroenterologico, Pad. C, 2° piano, AOU Policlinico Universitario, Via Consolare Valeria, 1-98125 Messina, Italy. cmorace@unime.it
authors.forename: C
authors.initials: C
authors.lastname: Morace
authors.forename: M
authors.initials: M
authors.lastname: Cucunato
authors.forename: R
authors.initials: R
authors.lastname: Bellerone
authors.forename: G
authors.initials: G
authors.lastname: De Caro
authors.forename: S
authors.initials: S
authors.lastname: Crinò
authors.forename: A
authors.initials: A
authors.lastname: Fortiguerra
authors.forename: F
authors.initials: F
authors.lastname: Spadaro
authors.forename: A
authors.initials: A
authors.lastname: Zirilli
authors.forename: A
authors.initials: A
authors.lastname: Alibrandi
authors.forename: P
authors.initials: P
authors.lastname: Consolo
authors.forename: C
authors.initials: C
authors.lastname: Luigiano
authors.forename: M L
authors.initials: ML
authors.lastname: Resta
authors.forename: O
authors.initials: O
authors.lastname: Ferraù
authors.forename: A
authors.initials: A
authors.lastname: Spadaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007335:Insulin-Like Growth Factor II / Q000032:analysis / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000378:metabolism; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000032:analysis / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D014408:Biomarkers, Tumor; C035170:IGF2 protein, human; D000509:alpha-Fetoproteins; D007335:Insulin-Like Growth Factor II