Chromogranin A levels in chronic liver disease and hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is the relevant cause of death in patients with compensated cirrhosis. Alpha-fetoprotein (AFP) is used for screening HCC, with limited success.AimWe evaluated plasma chromogranin A (CgA) as a marker of HCC.PatientsCgA plasma levels and AFP serum levels were prospectively measured in 30 patients with HCC, 14 with cirrhosis, 79 with chronic hepatitis and 65 controls.MethodsCgA was measured with an enzyme-linked immunosorbent assay (DAKO A/S Glostrup, Denmark). AFP was measured by electrochemiluminoimmunoassay (Elecsys, Roche S.p.A., Italy).ResultsCgA levels were significantly higher in the three groups of patients than in controls and in patients with HCC they were significantly higher than in chronic hepatitis patients [median 44.5 (interquartile range 21–145.9) U/L vs. 15.3 (10.9–29.25) U/L, p < 0.001]. AFP values were above the upper reference limit in 75% of patients with HCC, 50% of cirrhotic patients and 11% of chronic hepatitis patients (p < 0.005). CgA values significantly correlated with AFP levels (rs = 0.42, p < 0.0001). The overall diagnostic accuracy of CgA was 75% (CI 66–82), with a sensitivity of 70% (CI 50.6–85.2) and a specificity of 67% (CI 55.9–76.3).ConclusionsDespite the evidence of higher CgA levels in patients with HCC, this test has low-diagnostic accuracy. Its pathophysiological meaning remains unknown, even if it could suggest an endocrine phenotype of HCC.