title: Diagnostic and prognostic role of SCCA-IgM serum levels in hepatocellular carcinoma (HCC).
abstract: OBJECTIVE
  The serpin squamous cell carcinoma antigen complexed with IgM (SCCA-IgM) has been reported as a promising serological marker for hepatocellular carcinoma (HCC). We aimed to further evaluate SCCA-IgM diagnostic accuracy and to determine its prognostic role.
  
  
  METHODS
  SCCA-IgM levels were determined in 327 sera obtained from 81 HCC patients, 206 cirrhotics and 40 healthy blood donors (controls). Sensitivity, specificity, correlation with clinical and tumor parameters and with survival were evaluated.
  
  
  RESULTS
  HCC patients had SCCA-IgM levels significantly higher than controls and cirrhotics (P < 0.0001). Sensitivity, specificity, positive and negative predictive values for HCC were 89%, 50%, 41% and 92%, respectively. In comparison, sensitivity and specificity for alphafetoprotein were 48% and 85%. SCCA-IgM levels were not significantly correlated with clinical or biological variables. With a cut-off of 130 AU/mL (receiver operating characteristic curves), SCCA-IgM proved efficient in the prediction of prognosis, identifying the patients with long overall survival (efficiency validated in the homogenous subgroup of patients with intermediate-stage HCC undergoing transarterial chemoembolization) and predicting progression-free survival. A Cox multivariate analysis confirmed SCCA-IgM predictive value, identifying tumor size and SCCA-IgM levels as independent predictors of survival. A reduction in SCCA-IgM levels correlated with response to treatment.
  
  
  CONCLUSIONS
  SCCA-IgM is a sensitive marker of HCC in patients with cirrhosis even though lacking in specificity. The determination of the levels of the marker in HCC patients is highly efficient in predicting the patients' prognosis, identifying those with long overall and progression-free survival and the responders and should be introduced in the clinical practice.
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Pozzan
authors.forename: Romilda
authors.initials: R
authors.lastname: Cardin
authors.forename: Marika
authors.initials: M
authors.lastname: Piciocchi
authors.forename: Nora
authors.initials: N
authors.lastname: Cazzagon
authors.forename: Gemma
authors.initials: G
authors.lastname: Maddalo
authors.forename: Veronica
authors.initials: V
authors.lastname: Vanin
authors.forename: Anna
authors.initials: A
authors.lastname: Giacomin
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pontisso
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D015843:Serpins / Q000097:blood*
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D007075:Immunoglobulin M; D015843:Serpins; C051072:squamous cell carcinoma-related antigen
keywords: SCCA-IgM; diagnosis; hepatocellular carcinoma; prognosis; serological biomarkers