Assessment of fibroblast growth factor 19 as a non-invasive serum marker for hepatocellular carcinoma

BACKGROUND: Fibroblast growth factor 19 (FGF-19) is one of the founding members of the endocrine FGF subfamily. Recently, it has been the subject of much interest owing to its role in various physiological processes affecting glucose and lipid metabolism and the regulation of bile acid secretion as well as cell proliferation, differentiation, and motility. Additionally, FGF-19 secretion in an autocrine style has reportedly contributed to cancer progression in various types of malignancies including hepatocellular carcinoma (HCC). AIM: To estimate the serum FGF-19 concentrations in HCC cases and assess its diagnostic performance for the detection of HCC. METHODS: We recruited 90 adult participants and divided them into three equal groups: Healthy controls, cirrhosis patients, and HCC patients. Serum FGF-19 concentrations were measured using the Human FGF-19 ELISA kit. RESULTS: We detected a high statistically significant difference in serum FGF-19 levels among the three groups. The highest level was observed in the HCC group, followed by the cirrhosis and control groups (236.44 ± 40.94 vs 125.63 ± 31.54 vs 69.60 ± 20.90 pg/mL, respectively, P ≤ 0.001). FGF-19 was positively correlated with alpha fetoprotein (AFP; r = 0.383, P = 0.003) and international normalised ratio (r = 0.357, P = 0.005), while it was negatively correlated with albumin (r = -0.500, P ≤ 0.001). For the detection of HCC, receiver operating characteristic curve analysis showed that the best cut-off point of AFP was > 8.2 ng/mL with an area under the curve (AUC) of 0.78, sensitivity of 63.33%, specificity of 83.33%, positive predictive value (PPV) of 79.2%, negative predictive value (NPV) of 69.4%, and total accuracy of 78%. However, FGF-19 at a cut-off point > 180 pg/mL had an AUC of 0.98, sensitivity of 100%, specificity of 90.0%, PPV of 90.0%, NPV of 100%, and total accuracy of 98%. CONCLUSION: FGF-19 represents a possible novel non-invasive marker for HCC. It may improve the prognosis of HCC patients due to its utility in several aspects of HCC detection and management.