title: Evaluation of annexin A2 and as potential biomarkers for hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) ranks as the fifth most common malignancy worldwide. Early detection of HCC is difficult due to the lack of reliable markers. We aimed to assess the diagnostic role of annexin A2 (ANXA2) and follistatin as serum markers for HCC patients. This study included 50 patients with confirmed diagnosis of HCC, 30 patients with chronic liver disease, and 20 normal persons. Subjects performed thorough assessment and laboratory investigations. Serum levels of alpha fetoprotein (AFP), annexin A2, and follistatin were measured using ELISA technique. Annexin A2 significantly increased in the sera of HCC patients (median, 69.6 ng/ml) compared to chronic liver disease patients (median, 16.8 ng/ml) and control group (median, 9.5 ng/ml) (p < 0.001). Follistatin was higher in sera of HCC patients (median, 24.4 ng/ml) compared to the control group (median, 4.2 ng/ml) (p = 0.002) while no such significant difference was achieved between HCC and chronic liver disease patients. At a cutoff level 29.3 ng/ml, area under the receiver-operating characteristic curve for ANXA2 was 0.910 (95 % confidence interval (CI) 0.84-0.97). For follistatin, it was 0.631 (95 % confidence interval 0.52-0.74) at cutoff level 15.7 ng/ml. Combining both annexin A2 and AFP increased the diagnostic efficiency (98 % specificity, LR + 41 and 97.6 % PPV). Follistatin combined with AFP provided 92 % specificity while lower sensitivity (50 %) was observed. Serum ANXA2 is a promising biomarker for HCC, certainly when measured with AFP. Follistatin could not differentiate between HCC and chronic liver disease, but its combination with AFP improved the specificity for HCC diagnosis.
authors.affiliation: Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt.
authors.forename: Nevine
authors.initials: N
authors.lastname: El-Abd
authors.affiliation: Department of Clinical and Chemical Pathology, National Cancer Institute, Cairo, Egypt.
authors.forename: Amal
authors.initials: A
authors.lastname: Fawzy
authors.affiliation: Department of Endemic Hepatogastroenterology, Cairo University, Cairo, Egypt. tamerbaz@gmail.com.
authors.forename: Tamer
authors.initials: T
authors.lastname: Elbaz
authors.affiliation: Department of Endemic Hepatogastroenterology, Cairo University, Cairo, Egypt.
authors.forename: Sherif
authors.initials: S
authors.lastname: Hamdy
mesh_terms: D000328:Adult; D000368:Aged; D017306:Annexin A2 / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000175:diagnosis; D016022:Case-Control Studies; D003287:Contrast Media / Q000737:chemistry; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D038681:Follistatin / Q000097:blood; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008107:Liver Diseases / Q000378:metabolism; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C472822:ANXA2 protein, human; D017306:Annexin A2; D014408:Biomarkers, Tumor; D003287:Contrast Media; C503233:FST protein, human; D038681:Follistatin; D000509:alpha-Fetoproteins
keywords: AFP; Annexin A2; Follistatin; Hepatocellular carcinoma