Annexin A2 Versus Afp as An Efficient Diagnostic Serum Marker for Hepatocellular Carcinoma

AIM: To assess the annexin A2 versus AFP as an efficient Serum marker for Hepatocellular carcinoma diagnosis. Hepatocellular carcinoma is the third leading cause of cancer-related death, HCC prognosis is poor, and early detection is of the utmost importance. Although serum AFP is a useful biomarker for the detection and monitoring of HCC, the false-negative rate using the AFP level alone may be high. Several biomarkers are under research, one of them is annexin A2 (Annexin11, ANXA2) is a 36 kDa calcium-dependent phospholipid-binding protein that is presented on the surface of most eukaryotic cells, involving in several biological processes. METHODS: 105 patients were included , 70 of them were diagnosed as HCC ,these patients were divided into group 1 early stage HCC (n=37; male=23, female=14), and group 2 late stageHCC(n=43; male=29, female=14) and the other 35 patients (Group 3) were cirrhotics (20 males and15 females) beside that there were about 20 healthy control (Group 4). All subjects underwent a full history, physical examination and investigations, including: liver function tests, viral markers (HCV Ab and HBs Ag), AFP and evaluation of serum annexin A2 level and abdominal ultrasonography. On the other hand abdominal CT(was done for patients groups) and liver biopsy was done for diagnosis of hepatocellular carcinoma (group1). RESULTS: The mean level of serum annexin A2 in HCC patients were significantly higher than in the cases with liver cirrhosis or normal control (P<0.001), while no significant difference between liver cirrhosis and normal control. There was no significant relation with age, gender, S. albumin, S. bilirubin, S.ALT and hepatitis C infection. However there was a significant relation with hepatitis B infection. The specificity and sensitivity of serum annexin A2 and AFP measurements were represented by ROC curves. Area under ROC curve for AFP (AUC) was 0.84 with 0.75 to 0.910, 95% confidence interval with p<0.0001, the AUC for Annexin A2 was 0.89 with 0.81 to 0.95, 95% confidence interval with P<0.0001, AUC for both markers was 0.818 with 0.723 to 0.890, 95% confidence interval with P<0.0001, when comparing the sensitivity and specificity of annexin A2 with AFP or both markers they were; (78% & 91% for annexin A2 and 70.1% & 65.5% for AFP and 91.9% & 63.6% for both). CONCLUSION: Serum level of annexin A2 can be a good marker for HCC, with higher sensitivity, specificity, positive and negative predictive value than AFP. Complementary diagnostic value was achieved by measuring both annexinA2 &AFP for HCC diagnosis, we found sensitivity and negative predictive value were higher than in either both.