Role of serum C-reactive protein as a marker of hepatocellular carcinoma in patients with cirrhosis

Background: The usefulness of C-reactive protein (CRP) as a tumour marker i n patients with hepatocellular carcinoma (HCC) is controversial. The purpos e of this study was to determine whether CRP estimation could be used to id entify patients with HCC among those with cirrhosis. Methods: Serum levels of CRP and alpha-fetoprotein (AFP) were investigated in 122 previously untreated patients with cirrhosis and HCC. Another 76 pat ients with cirrhosis alone were also investigated as controls. Results: Of the subjects tested, 47.5% of patients with HCC and 39.5% of co ntrols had elevated CRP values (> 6 mu g/mL). Although using elevated CRP a nd/or AFP (> 20 ng/mL) as a criterion showed a significant difference betwe en controls and patients with multiple nodular, massive, or diffuse type HC C (all P < 0.005), the clinical application of this criterion was limited b ecause of low specificity (58%) and accuracy (all < 73%). By using receiver -operating characteristic curves no valuable threshold value of CRP was fou nd to discriminate various types of HCC, except for distinguishing the diff use type from controls. The CRP value of 12 mu g/mL could be used as the cu t-off value to differentiate diffuse-type HCC from controls (sensitivity 82 .4%, specificity 82%, accuracy 82.1%, P < 0.005). Conclusions: Serum CRP is not a good marker for HCC. However, very high val ues of CRP in patients with cirrhosis may suggest the presence of a diffuse -type HCC. (C) 2000 Blackwell Science Asia Pty Ltd.