ABSTRACT
Early diagnosis of hepatocellular carcinoma [HCC] is the only hope for cure. Although the role of alpha foetoprotein [AFP] in the diagnosis of advanced HCC is well recognised, at least one-third of cases will be missed unless another diagnostic tool is used. Increased levels of circulating interleukin-18 [IL-18] have been observed in patients with several cancer types and were described in patients with chronic hepatitis. The aim of this study is to assess the role of serum IL-18 level in the diagnosis of hepatitis C virus [HCV]-related HCC. A total of 75 subjects categorised into four groups, including 25 patients with HCV-related HCC and AFP above 200 ng/ml, 25 patients with HCV-related HCC and AFP below 200 ng/ml, 15 patients with HCV-related chronic liver disease and 10 healthy controls, were enrolled. HCC was diagnosed according to guidelines of the American Association for the Study of Liver Diseases. AFP and IL-18 were assessed in all subjects. AFP and IL-18 levels are significantly higher in patients with HCC than in disease control and healthy control subjects. IL-18 level is not correlating with the size or the number of hepatic focal lesions neither with the presence of lymphovascular invasion or abdominal lymphadenopathy. The best cut-off value of IL-18 for the diagnosis of HCC is 500 pg/ml with 84% sensitivity and 86.7% specificity and the area under receiver operating characteristic curve is 0.675. Serum IL-18 level is a suitable marker for the diagnosis of HCV-related HCC complementary to AFP, especially in cases with AFP level less than the diagnostic value