This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third cancer killer. The incidence rates of HCC in the United States increased two-fold during the last two decades. The reason for this increase is clearly linked to the rise in the incidence of liver cirrhosis related to chronic hepatitis C (HCV). Not all cirrhotics and not all patients with chronic HCV infection will develop HCC. Therefore, environmental factors such as obesity, tobacco, alcohol and coffee intake may play a role in the progression from cirrhosis to HCC. Survival in patients with HCC improved minimally over the last two decades, from a 5-year survival rate of 2% in 1983 to 4% in 1998. This is because most patients with HCC are diagnosed in an advanced stage at which curative treatment is not available. This is mostly related to the poor performance of the currently used tumor marker, alpha-fetoprotein (AFP). Therefore, newer and effective methods of diagnosis are needed. Des-gamma carboxyprothrombin (DGCP) and lens culinaris agglutinin - reactive AFP (AFP-L3) have been found to have superior performance than AFP in other populations, yet further studies in the expression of these biomarkers are needed to confirm these findings.
The aims of this proposal are: (a) to determine whether obesity, tobacco, alcohol and coffee consumption are associated with HCC status and (b) to determine the performance characteristics of AFP, DGCP, AFP-L3 for the diagnosis of HCC. In order to achieve the aims of this study, we will enroll patients at two academic institutions in Puerto Rico to perform a case control study of patients with cirrhosis and HCC. We will obtain demographics, medical history, history and etiology of liver disease, family history, social history (with attention to lifetime alcohol, tobacco and coffee consumption), weight history, and clinical and laboratory data of patients with cirrhosis and HCC. All the data obtained will be kept in a password-protected dedicated computer in the Gastroenterology Research Unit of the University of Puerto Rico. We plan to enroll 54 HCC patients and 96 cirrhosis controls during the second year of this study. This is an important study in the continued search for a much-needed tumor marker for HCC. The increasing incidence and poor survival of this cancer may have important public health implications in the next decades.
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