The evaluation of the risk of hepatocellular carcinoma development using glypican-3, heat shock protein -70, CD-34 and glutamine synthetase in pati-ents with advanced fibrosis or cirrhosis secondary to chronic hepatitis B

Hepatocellular carcinoma (HCC) is the sixth most common cancer. It is the third most common cause of cancer death (1). Chronic hepatitis B (CHB) patients consti-tute more than half of HCC patients. The main cause of death in HCC patients is to diagnose these patients in advanced stage. Therefore early diagnosis is very impor-tant to improve clinical outcomes such as mortality rate, successful transplantation outcome. (133). CHB patients followed in Hacettepe University Hospital between January 2003 and December 2013 with advanced fibrosis or cirrhosis (fibrosis ac-cording to Ishak scoring ≥4) were included in our study. In addition, 10 patients with CHB with fibrosis score <3 and who did not develop HCC were included as a control group. Both HCC and CHB biopsy materials were re-evaluated by using glutamine synthetase (GS), heat shock protein-70 (HSP-70), CD 34 and glypican-3 (GPC-3), which are tissue markers used in the diagnosis of early HCC. A single, experienced pathologist evaluated all specimens inculuded in the study. The purpose of staining with these markers is to test the presence of a cellular disorder/atypia before the clinical presentation of HCC. It was thought that detection of these markers in non-HCC patitents whom eventually developed HCC would change the screening algo-rithm for HCC in these patients. In patients who eventually developed biopsy-confirmed HCC, GS was weakly stained in all non-neoplastic specimens. Almost all neoplastic (87.5%) specimens showed strong GS staining. HSP-70 was strongly stained in 50% of non-neoplastic and 87.5% of neoplastic specimens. CD 34 was weakly stained in 87.5% of non-neoplastic spe-cimens. All neoplastic tissues showed strong CD 34 staining. GLP-3 was strongly sta-ined in 87.5% of both non-neoplastic and neoplastic specimens. GPC-3 staining pat-tern was similar in both non-neoplastic and neoplastic tissues. Therefore, strong GPC-3 staining of liver biopsy of CHB patients with cirrhosis may predict eventual development of HCC.