Urinary transforming growth factor α and serum α-fetoprotein as tumor markers of hepatocellular carcinoma

This case-control study aimed to evaluate the diagnostic application of urinary transforming growth factor (TGF) alpha and serum alpha-fetoprotein (AFP) in hepatocellular carcinoma (HCC). TGF alpha and AFP were determined in 90 pairs of age- and gender-matched patients with cirrhotic HCC and patients with cirrhosis alone and 60 healthy controls. The results indicated that TGF alpha and AFP levels in patients with HCC were higher than in those with cirrhosis alone or healthy controls (each P = 0.0001). Multivariate analysis indicated that TGF alpha (odds ratio (OR) 1.03, 95 % confidence interval (CI) 1.05-1.16) and AFP (OR 1.03, 95 % CI 1.01-1.06) were closely associated, in a dose-related fashion, with the development of HCC. The optimal cutoff values, determined with the receiver operating characteristic (ROC) curves, were 29 mu g/g creatinine for TGF alpha and 100 ng/ml for AFP, respectively. The areas under ROC curve (AUC) were 0.74 for TGF alpha and 0.78 for AFP, respectively. Both biomarkers showed the same sensitivity (52.2 %), high specificity, high positive predictive value, and moderate positive likelihood ratio. Determination of both markers in parallel significantly increased the AUC (0.91) and diagnostic accuracy (92.2 %), with a high sensitivity (86.7 %), specificity (97.8 %), positive predictive value (PPV; 97.5 %), and moderate positive likelihood ratio (PLR; 39.4). Among 31 cirrhotic HCC with AFP a parts per thousand currency signaEuro parts per thousand 20 ng/ml, the calculated AUC for TGF alpha was 0.79, with a sensitivity of 64.5 %, specificity of 96.7 %, PPV of 87.0 %, and PLR of 19.5. In conclusion, urinary TGF alpha and serum AFP are complementary tumor markers for detection of HCC with low AFP production.