ELEVATED URINARY TRANSFORMING GROWTH-FACTOR-BETA-1 LEVEL AS A TUMOR-MARKER AND PREDICTOR OF POOR SURVIVAL IN CIRRHOTIC HEPATOCELLULAR-CARCINOMA

To assess the clinical relevance of transforming growth factor-beta 1 (TGF-beta 1) in hepatocellular carcinoma (HCC), urinary TGF-beta 1 and serum alpha-fetoprotein (AFP) were determined in 94 patients with cir rhotic HCC, 94 age- and sex-matched patients with cirrhosis alone and 50 healthy adults. TGF-beta 1 level in HCC was higher than in cirrhosi s alone or in healthy controls (each P = 0.0001). There is an inverse correlation between TGF-beta 1 and AFP levels (r= -0.292, P = 0.004). Significantly higher TGF-beta 1 level was found in HCC patients with w orsening Child-Pugh stages, diffuse HCC, tumour size greater than or e qual to 3 cm, multilobular tumour and AFP less than or equal to 20 ng ml(-1). TGF-beta 1 level decreased after complete treatment with trans catheter arterial chemoembolization (P = 0.0001). The median survival in HCC patients with raised TGF-beta 1 was shorter than those with nor mal TGF-beta 1 (P = 0.018). Multivariate analysis indicated that TGF-b eta 1 and AFP were significantly correlated with the presence of HCC. In addition, TGF-beta 1 could be used as a diagnostic marker for HCC, particularly in tumours with low AFP production. In conclusion, elevat ed urinary TGF-beta 1 level is a tumour marker and predictor of poor s urvival for cirrhotic HCC.