Low serum retinol levels are associated with hepatocellular carcinoma in patients with chronic liver disease

Background: Retinol and other vitamin A derivatives affect the differentiat ion and growth of many tissues and have anti-tumour properties. Aim: To investigate serum retinol levels in patients with liver disease and hepatocellular carcinoma (HCC) and to assess its importance as a risk fact or for the development of HCC. Methods: Serum retinol levels were measured in healthy volunteers and 175 p atients (34 with chronic hepatitis C, 117 with cirrhosis, and 24 with HCC. Results: The serum retinol levels (mean +/- s.e.) in ng/mL, were 972.1 +/- 37.7 in the control group and 647 +/- 41.1 in patients with chronic hepatit is C. Serum retinol levels in patients with cirrhosis and HCC were lower th an in patients with cirrhosis alone (365.8 +/- 43.1 vs. 438.9 +/- 22.1, P < 0.04). In particular, there was a more significant difference in serum ret inol levels between Child-Pugh grade A patients with cirrhosis and Child-Pu gh grade A patients with cirrhosis/HCC (serum retinol levels 532.4 +/- 26.7 vs. 366.1 +/- 86.4, P < 0.03). There was a significant difference in serum retinol levels between normal controls and all patients' groups (P < 0.001 ). There were significantly lower serum retinol levels in cholestatic Child -Pugh grade A patients with cirrhosis compared with noncholestatic Child-Pu gh grade A patients with cirrhosis/HCC (411.5 +/- 30.3 vs. 579.7 +/- 32.7, P < 0.0004). Sixty percent of patients with Child-Pugh grade A cirrhosis/HC C had serum retinol levels below 350 ng/mL compared with only 18.4% of cirr hotics without HCC (chi (2)-test, P=0.01). No correlation was found between serum retinol levels and alpha FP or any other liver function tests, apart from serum albumin, which showed a positive correlation (r=0.61 P < 0.018) . Conclusions: There was a progressive reduction in serum retinol levels from controls to patients with liver cirrhosis. Those patients with cirrhosis a nd HCC had significantly lower values than patients with cirrhosis alone. S erum retinol levels may be a risk factor for the development of HCC.