Urine Tests Improve Detection of Liver Cancer and Cholangiocarcinoma
11 May 2013
New data from two clinical trials demonstrate substantial improvements in the detection of both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) using diagnostic urine tests.
Preliminary data demonstrate the performance of urinary metabolites in helping to diagnose HCC. Urine samples were collected from four subject groups in West Africa on the case-control platform of PROLIFICA (Prevention of Liver Fibrosis and Carcinoma in Africa) as follows: patients with HCC (n=65), cirrhosis (Cir, n=36), noncirrhotic liver disease (DC, n=110) and healthy controls (NC, n=91). HCC patients were diagnosed using European Association for the Study of the Liver (EASL) guidelines.
Multivariate analyses of urinary nuclear magnetic resonance (NMR) spectra showed a distinct profile for urine of patients with HCC compared to Cir, DC and NC with sensitivity of 87%, 86% and 97% respectively. These results suggest that urinary metabolite profile outperforms serum alpha-fetoprotein (AFP), which only differentiated HCC from these groups by 79% (Cir), 75% (DC) and 76% NC) respectively.
The metabolites that were significantly increased (p < 0.001) in HCC patients compared to all groups of control were methionine, acetylcarnitine, carnitine, N-acetylglutamate, 2-oxoglutarate, indole-3-acetate, and creatine; whereas creatinine was significantly lower in HCC than controls.
The overall survival rate of HCC is poor and screening for HCC offers the best hope for early detection, eligibility for treatment, and improved survival. While effective therapies exist, the available screening tests to detect HCC, alpha-fetoprotein (AFP) and ultrasound, are reported to have low sensitivity and specificity (50%–85% and 70%–90%, respectively).
EASL general secretary, Prof. Mark Thursz commented: "These findings will be welcomed by physicians as they validate urinary metabolic profiling as a potential screening tool for HCC, with superior diagnostic accuracy to serum AFP and if investigated further and put into practice, this noninvasive technique could simplify and improve clinical diagnosis and outcomes for patients."
Similarly, a phase II study showed that a combined bile and urine proteomic test increased diagnostic accuracy of CC in patients with biliary strictures (an abnormal narrowing of the common bile duct) of unknown origin.
These data were presented in April 2013 at the International Liver Congress 2013 held in Amsterdam (Holland).