Assessment of Serum Retinol Binding Protein 4 in Patients with Hepatocellular Carcinoma

Abstract

Introduction: Retinol Binding Protein 4 (RBP4) may be indirectly involved in the induction of carcinogenesis as it was identified as a key regulator of insulin resistance in obesity and diabetes. Data about serum level of RBP4 in patients with Hepatocellular Carcinoma (HCC) are rare. The role of RBP4 in liver cirrhosis has to be further investigated as it may act as a novel biomarker for screening of HCC. Aim: To determine the value of serum RBP4 in Egyptian patients with Hepatitis C Virus (HCV) (genotype 4) related liver cirrhosis and HCC. Materials and Methods: This study was a randomised, crosssectional, comparative study designed to measure serum RBP4 level in patients with HCV-related cirrhosis. Ninety patients were randomly recruited between October 2016 and November 2017 from the Hepatology outpatients’ clinic of Ain Shams University Hospitals and were divided into two groups as follow: Group I: 60 patients with HCV related liver cirrhosis and HCC, Group II: 30 patients with HCV related liver cirrhosis. Data were analysed with the program Statistical Package for Social Science (SPSS) under windows version 11.0.1. The statistical analysis was calculated using Student’s t-test (t), Pearson Correlation coefficient (r) test, chi-square test (c2 ). Results: The study revealed that patients with HCC had higher levels of serum RBP4. However, neither the number of hepatic focal lesions nor the total tumour burden had any significant correlation with serum RBP4 (p-value: 0.440 and 0.193 respectively). Serum RBP4 had also insignificant correlations with Child-pugh score, Model for End Stage Liver Disease (MELD), score Homeostasis Model of Assessment-Insulin Resistance index (HOMA-IR) and Body Mass Index (BMI). Serum RBP4 at a cut-off value >12.5 mg/mL had 73.3% sensitivity and 53.3% specificity for detection of HCC (overall accuracy=67.6%). Notably, higher values of HOMA-IR index were found among patients with HCC (mean value 2.838±1.827; range 0.400-7.300). Conclusion: RBP4 was significantly re-upregulated in patients with HCC from its reduced levels in cirrhotic patients. RBP4 has the potential to be a biomarker for the screening of HCC.

Keywords

• cirrhosis
• hepatitis c virus
• insulin resistance