Evaluation of Tumor Markers Among Patients with Hepatitis C Infection.cdr

PBMJ VOL. 5, Issue. 5 May 2022 Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers Received Date: 21st May, 2022 Acceptance Date: 27th May, 2022 Published Date: 31st May, 2022 DOI: https://doi.org/10.54393/pbmj.v5i5.475 Bhatti S et al., Hepatitis C, Tumor Marker, Liver Cancer, Biomarker, CA19-9, CA125, CA15-3 and AFP Bhatti, S. ., Saeed, A. ., Ahuja, K., Memon, K. . ., Khatoon Bhatti, N. ., & Qasim Ujjan, G. . (2022). Evaluation of Tumor Markers Among Patients with Hepatitis C Infection. Pakistan BioMedical Journal, 5(5). https://doi.org/10.54393/pbmj.v5i5.475 How to Cite: *Corresponding Author: Shameem Bhatti Department of Pathology Pir Syed Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Pakistan


I N T R O D U C T I O N
Tumor markers are biomolecules found in blood, urine and tissue of individuals and, with particularly high concentration in most cancers, therefore, their concentration has diagnostic value. These markers may be used for screening, identi cation (type and stage), monitoring, and predicting prognosis. Increases in tumor markers are sometimes seen in patients with chronic liver disease without hepatocellular carcinoma (HCC). Objective: To determine the tumor markers, present among patients with Hepatitis C infection. Methods: From April 2021 to March 2022, serum samples from 700 HCV patients who presented to the Department of Pathology at the Pir Syed Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat Khairpur Mirs, were used in this descriptive, cross-sectional study. Using the ACCESS-2 system, serum samples were analyzed for the presence of the speci ed tumor markers. Results: There was a signi cant increase in CA125 (P = 0.03) and AFP levels (P = 0.03). CA19-9, CEA, and CA15-3 levels in the blood were unremarkable (P > 0.05). It is too early to say if the increase in CA125 or AFP will lead to eventual carcinoma based on this study, but it deserves further exploration using a longitudinal research methodology. Conclusion: CA125 and AF (P were the most common tumor markers found in HCV patients. Given the association of the aforementioned indicators with hepatic cancer, HCV patients with CA125 and AFP levels over normal should be considered high-risk. concentration in most cancers, therefore, their concentration has diagnostic value [6,7]. These markers may be used for screening, identi cation (type and stage), monitoring, and predicting prognosis of cancer [8,9]. Patients with chronic liver illness but no hepatocellular carcinoma may see an increase in tumor markers (HCC). This could be a sign of imminent cancer and thus an opportunity to intervene quickly, avoiding a poor outcome and gaining a favorable prognosis. The goal of this study was to evaluate the levels of tumor markers in patients with Hepatitis C infection in order to identify HCV carriers who are at high risk for cancer development. Alpha Fetoprotein (AFP): This fetal speci c glycoprotein is primarily developed in the fetal liver. In normal circumstances the serum concentration of AFP falls immediately following the birth and hereafter, all production is repressed. It has been noted 7 out of every 10 HCC patients have elevated levels of AFP in the serum (attributed to secretion by the tumor). To date, serum AFP is regarded as the tumor marker that is most useful in screening HCC among suspected patients. Commonly, a s e r u m co n ce n t rat i o n of 3 0 n g /m L i s d e e m e d a differentiation point or a cut-off value between normal individual and HCC patients (Sensitivity:65% and Speci city: 89%) [10]. CA 15-3: Secreted by normal cells in the breast, this murine monoclonal antibody (molecular weight: 300-450 kDa) is particularly elevated among patients with cancerous tumors (in the breast and/or elsewhere). The point of differentiation between healthy and diseased (cancerous) individuals is a concentration is 25 U/ml for CA 15-3. The marker is also known to be elevated among conditions other than hepatocellular carcinoma, such as cancer of the lungs, colon, rectum, and breast [11]. CA 19-9: The carbohydrate antigen 19-9 (CA19-9) is a known marker for illness states such as colon cancer and g a st ro i n te st i n a l a d e n o c a rc i n o m a . T h e p o i n t of differentiation between healthy and diseased (cancerous) is a concentration of more than 37 U/ml. In addition to hepatocellular carcinoma, the serum concentrations of this marker are also hiked among patients with cancer of the stomach, lungs, colon, and pancreas [12]. CA 125: This carbohydrate-related high molecular mass glycoprotein (molecular weight: >200 kDa) marker is a carbohydrate antigen that can be found in up to 80% of nonmucinous ovarian cancer cases. The marker is primarily a monoclonal antibody. The point of differentiation between healthy and disease (cancerous) cases is a serum concentration of an upwards of 35 U/ml. In addition to hepatocellular carcinoma, the serum concentration of CA125 is elevated among patients with cancer of the lungs,

PBMJ VOL. 5, Issue. 5 May 2022
Copyright (c) 2022. PBMJ, Published by Crosslinks International Publishers endometrium, pancreas, breast, and colon [13,14]. CEA: This antigen is an oncofetal antigen that is linked to a wide group of cell surface glycoproteins (molecular weight: 150-300 kDa) that are found on numerous cell types but have much higher concentrations in tumour patients and fetuses (normal). Smokers and nonsmokers have various points of differentiation (between normal and ill persons), namely 2.5g/l and 5.0g/l, respectively.

M E T H O D S
This descriptive, cross-sectional study was conducted from April 2021 to March 2022 using serum samples of 700 HCV patients, presenting to the Dept. of Pathology at Pir Syed Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Khairpur Mirs. The serum samples were checked for the existence of the listed tumor markers by ELISA using ACCESS-2 machine. ACCESS-2 can identify the following prominent biomarkers, among others. Since the levels (obtained via biochemical tests) of biomarkers can vary with time and between patients, the principles of best practice state that an arithmetic mean be used. Inclusion criteria was con rmed cases of HCV. Exclusion criteria was patients receiving hepatitis medication / Antiviral Therapy. Interferon-alpha (Subcutaneous Inj.) in combination oral Ribavirin & Lamivudine. Proven cases of hepatocellular carcinoma (HCC).

R E S U L T S
The mean age of the sample stood at 43 (SD± 3) years, with most of the sample comprising of males (59.29%), and the remaining being females (40.71%). Patients (73.14%) hailed from an urban setting while the remaining had a rural (26.86%) residence. A summary of the sociodemographic characteristics of the sample population are tabulated below. An increase in CA125 and AFP levels, was noted. Levels (in serum) of tumor marker CA15-3, CA19-9, and CEA were unremarkable. A variety of markers are used for HCC and among the said markers is serum alpha-fetoprotein (AFP), which is used widely and with great effect. However, it is noted that serum AFP levels are oftentimes increased among patients with ailments of the liver other than HCC. The same conditions may also infect patients concurrently with HCV in up to 42% of the cases, putting the speci city of AFP (with regards to HCV) into doubt [15]. In this research, an 85% of the sample population had a raised AFP level. Research suggests that the hiked levels of AFP result from hepatocyte destruction (due to viral hepatitis) and consequent attempts of regeneration [16]. Recently, more alternatives have surfaced that outperform AFP in terms of speci city for HCC, [17] such as the "Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3%)" [12] and "des-c-carboxy prothrombin (DCP)" [18]. The Access-2 machine used in this research does not measure the said markers were not made a part of this research. It is noteworthy that AFP is more suited (as a diagnostic marker) to HBV, than HCV. Literature suggests that diagnostic accuracy deteriorates in cumulative samples when the proportion of HCV patients is higher than the proportion of HBV patients in the sample set [19]. Another marker that this research focused upon was CA125.
Research suggests a signi cant correlation between CA125 and infection with hepatitis (P=0.01). CA125 is sensitive to benign and neoplastic pathologies of the liver

C O N C L U S I O N S
After careful consideration and a thorough evaluation CA125 and AFP were the prominent tumor markers detected among patients with hepatitis C. Keeping in view the co-occurrence of the said markers with hepatic carcinoma, it is advised that hepatitis C patients with CA125 and AFP levels above normal may be treated as highrisk patients.