title: Diagnostic and mechanistic implications of serum free light chains, albumin and alpha-fetoprotein in hepatocellular carcinoma.
abstract: BACKGROUND
  Mass spectroscopy analysis suggested low serum albumin and high immunoglobulin free light chain (sFLC) levels may have diagnostic value in hepatocellular carcinoma (HCC). Our aims were to apply quantitative assays to confirm these observations, determine their diagnostic utility, and investigate the mechanisms involved.
  
  
  METHODS
  Albumin, sFLC, routine liver and renal function tests were measured in patients with chronic liver disease with (n=102) and without (n=113) HCC. The discriminant performance was compared with the current standard serological test alpha-fetoprotein (AFP) using receiver operating characteristic (ROC) and area under the curve (AUC) analyses.
  
  
  RESULTS
  sFLC and serum albumin were each confirmed to have discriminatory utility in HCC with AUC values of 0.7 and 0.8, respectively. sFLC were strongly correlated with gammaglobulin levels and both these were inversely related to serum albumin levels. The discriminatory utility of sFLC was retained after adjusting for renal and liver function.
  
  
  CONCLUSIONS
  Serum levels of sFLC and albumin were strongly associated with HCC as predicted by mass spectroscopy. Discrimination of HCC by AFP was improved by the addition of either albumin or sFLC. Larger prospective studies are required to determine how AFP, sFLC and albumin might be combined in a useful diagnostic approach for HCC.
authors.affiliation: Cancer Research UK, Institute for Cancer Studies, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK.
authors.forename: M
authors.initials: M
authors.lastname: Teng
authors.affiliation: Cancer Research UK, Institute for Cancer Studies, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Pirrie
authors.affiliation: Cancer Research UK, Institute for Cancer Studies, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Ward
authors.affiliation: The Binding Site Group Limited, 8 Calthorpe Road, Edgbaston B15 1QT, UK.
authors.forename: L K
authors.initials: LK
authors.lastname: Assi
authors.affiliation: The Binding Site Group Limited, 8 Calthorpe Road, Edgbaston B15 1QT, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Hughes
authors.affiliation: Cancer Research UK, Institute for Cancer Studies, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK.
authors.forename: D
authors.initials: D
authors.lastname: Stocken
authors.affiliation: Cancer Research UK, Institute for Cancer Studies, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Johnson
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D008113:Liver Neoplasms / Q000175:diagnosis*; D013058:Mass Spectrometry; D012709:Serum Albumin / Q000032:analysis*; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D007147:Immunoglobulin Light Chains; D012709:Serum Albumin; D000509:alpha-Fetoproteins