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Urinary metabolite panel effectively diagnosed HCC stage in West African patients

Urinary metabolites outperformed serum alpha fetoprotein in monitoring specific stages of hepatocellular carcinoma in patients in West Africa, according to new research data.

Researchers collected urine samples from 290 participants in the Prevention of Liver Fibrosis and Cancer in Africa program (63 with hepatocellular carcinoma (HCC), 32 with cirrhosis, 107 with noncirrhotic liver disease and 88 healthy volunteers). They also assessed urine samples from 463 participants in a validation cohort (141 with HCC, 56 with cirrhosis, 178 with noncirrhotic liver disease and 88 healthy volunteers) to determine urinary metabolite performances in HCC patients.

Researchers concluded that urinary metabolite panels positively correlated to clinical stages of HCC compared with serum alpha fetoprotein (AFP; P=.7). HCC patients had greater amounts of metabolites in their urine, and AFP was lower compared with controls. HCC patients in both cohorts showed similar urinary metabotype panels under the receiver operating characteristic curves compared with cirrhotic, noncirrhotic and healthy participants.

Inosine, indole-3-acetate, galactose and N-acetylated amino acid (NAA), as part of one urinary metabolite panel, displayed an average high specificity ([90.3% (74.2-98)]) and sensitivity ([86.9% (75.8-94.2)]) among HCC patients without cirrhosis under the receiver operating characteristic curves. The same panel was validated in the second cohort; AFP had lower sensitivity and specificity with this panel also.

Researchers said elevated metabolite levels of NAA, creatine, choline, dimethylglycine, 2-oxoglutarate, methionine, acetylcarnitine, and 1-methylnicotinamide in urine of HCC patients correlated with clinical stages of HCC.

“These findings confirm that a panel of urinary metabolites may prove useful for screening HCC in at-risk populations,” the researchers wrote. “Further verification and discovery of additional urinary metabolites by mass spectrometry and identification of a combination of metabolites integral to diagnosis of small HCCs would be the most rational direction of future research.”

Disclosure: Nimzing G. Ladep, MBBS, FWACP, reports fellowship support from the Trustees of the London Clinic and British Medical Research Council ICIC. Mary M.E. Crossey reports fellowship support from the Halley Stewart Foundation.