Clinical Utility of Serum Endoglin (CD105) in Patients with Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide with about 600,000 patients dying from the disease annually. HCC accounts for 85 % to 90 % of primary liver cancers. The most common risk factors of HCC are chronic hepatitis and liver cirrhosis caused by hepatitis B virus infection and hepatitis C virus infection. The diagnosis of HCC is mainly based on a combination of abdominal ultrasound and serum alpha fetoprotein level. However, tumors that are too small will be missed by abdominal ultrasound and serum alpha fetoprotein level which lacks organ and tumor specificity and has low sensitivity particularly in early stage disease. Clearly, the available screening methods are inadequate for early detection and follow up of HCC, so there is need for other markers have to high sensitivity in early diagnosis of HCC as well as the specificity in differentiation between HCC and benign lesions. Endoglin is an integral homodimer membrane glycoprotein receptor of the TGF-β superfamily. Endoglin is highly expressed in vascular endothelial cells at sites of active angiogenesis. In liver, expression of endoglin is confined to hepatic stellate cells (HSC), Kupffer cells and sinusoidal endothelial cells. Many reports demonstrated elevated serum endoglin levels in various malignancies as in breast cancer and colorectal carcinoma. In this regard, the present study aimed to evaluate the clinical significance of serum endoglin as a novel cancer marker in HCC and comparing it to AFP, the conventional marker of hepatocellular carcinoma. This study was conducted on 70 patients attending the Internal Medicine Department of Ain Shams University Hospitals in addition to 20 apparently healthy control subjects. Patients were divided into two groups according to their diagnosis. Group I included 35 HCC patients and Group II included 35 patients with chronic liver disease. All patients in this study were subjected to full history taking, thorough clinical examination, radiological investigations including abdominal U/S and CT scan, routine laboratory investigations and serum AFP in addition to serum endoglin assay by sandwich ELISA technique. Serum AFP was significantly higher in patients with chronic liver disease when compared to control group. Serum AFP was also significantly higher in HCC group when compared to chronic liver disease group or control group.