Peripheral Mononuclear Cells Surface Markers Evaluation in Different Stages of Hepatocellular Carcinoma; in a Trial for Early and Accurate Diagnosis in Patients with Post-Hepatitis Liver Cirrhosis and Unremarkable Raised AFP

INTRODUCTION: HCC is frequently diagnosed late, when only palliative treatment is available. So, we try to use different immunological markers to identify early HCC in patients with unremarkable raised AFP. METHODS: This study was conducted on 112 participants divided into two equal groups: Group I, 56 patients with liver cirrhosis and different stages of HCC; Group II, 56 patients with liver cirrhosis. The diagnosis of HCC was based on AASLD guidelines. TNM and BCLC classification systems are used for staging of HCC. RESULTS: A significant reduction in the median percentage of lymphocyte subset (CD3(+), CD4(+), CD8(+), CD19(+)) and NK cell percentage (CD56(+)) has been detected in HCC patients (all P < 0.001). In the HCC group the median monocyte subpopulations CD14(+) CD16(−) Classical, CD14(++) CD16(+) Intermediate, and CD14(−+) CD16(++) Non-Classical were 11.7, 4.0, and 3.5, respectively, with marked reduction compared with liver cirrhosis group (all P < 0.001). Patients with advanced stages (BCLC C and D) were more likely to have significantly higher median CD33(+) than patients with early stages (BCLC A and B) (P = 0.05); also, the median levels of HLA DR(+) lymphocytes % in the HCC case group were 21.8 in patients with advanced disease (BCLC C and D) and 13.1 in patients with early stages of the disease (P = 0.04). Patients with late stage (TNM III) were more likely to have significantly higher median CD14(+) CD16(−) Classical monocyte subset, CD36(+) HLA DR(+), and CD36(+) CD16(−) than patients with early stages (TNM I and II). CONCLUSION: Patients with HCC with unremarkable raised AFP showed marked reduction in lymphocytes, natural killer cells, and all monocyte subpopulations. In addition, patients with advanced HCC showed increased CD33(+) and HLA DR(+) lymphocytes %, CD14(+) CD16(−) Classical monocyte subset, CD36(+) HLA DR(+), and CD36(+) CD16(−) compared with patients with early stages of HCC.