ABSTRACT
Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. Currently, the rate of HCC is rising throughout the world, including the United States. The vast majority of HCC is diagnosed in a late stage, leading to poor prognosis. Surgical resection, including liver transplantation, is the only potentially curative therapy if HCC is diagnosed in an early stage. However, a significant number of patients develop recurrent HCC despite receiving surgical resection or liver transplantation. Therefore, screening for HCC in patients with cirrhosis and the ability to predict individual recurrence risk, including assessing prognosis are important in guiding therapy. Current screening criteria for HCC include the combination of serum a-fetoprotein (AFP) and an ultrasound of liver at six-month intervals in patients with cirrhosis. However, AFP has a poor sensitivity and specificity for the early diagnosis of HCC. Therefore, additional tumor or molecular markers need to be studied for their utility for screening and assessing prognosis of HCC in future studies. Several tumor markers including AFP-L3, des-g-carboxyprothrombin (DCP), Golgi protein 73 (GP73), hepatoma-specific gglutamyl transferase (HS-GGT), human cervical cancer oncogene (HCCR), and telomerase have been identified as potential tumor markers for screening for HCC in patients with cirrhosis. Furthermore, recent advancements in the understanding of hepatic carcinogenesis have also resulted in investigations of several tumor markers and molecular biomarkers for their screening potential and prognostic significance in terms of angiogenesis, invasion, and metastasis in patients with HCC. In addition, proteomics analysis might be expected to generate new HCC-specific markers in the future. Recently, several potential molecular markers including Bcl-2, heat shock protein (HSP), vascular endothelial growth factor (VEGF), interleukin-8 (IL-8), angiopoietins, and matrix metaloproteinases have shown promise in clinical studies as prognostic markers following resection of HCC for recurrence and/or overall survival in patients with HCC. This chapter reviews a number of tumor markers, including molecular biomarkers, with potential as tools for early identification of HCC and prognostic indication.
