Comparison of Serum Survivin and Alpha Fetoprotein in Egyptian Patients with Hepatocellular Carcinoma Associated with Hepatitis C Viral Infection

Background: Survivin is specific antiapoptotic gene product expressed in a variety of human neoplasmswhose overexpression might assist in early diagnosis and as a prognostic marker.
Objectives: The aim was to evaluate the plasma levels of survivin and alpha fetoprotein in patients with chronic hepatitis C viral infection (HCV) with and without hepatocellular carcinoma (HCC). Subjects: 70 subjects were divided into: a control group (Group I) ( 20 healthy volunteers ) and two patients groups: Group II, HCV group (20 patients); and Group III, HCC with HCV(30 patients ).
Methods: Thorough physical examination, ultrasonography of the abdomen, laboratory investigations (liver profile, anti-HCV antibodies, hepatitis B surface antigen, Alpha fetoprotein (chemiluminometry) and Survivin (ELISA)) were performed.
Results: There was a significant increase in survivin level in HCV patients (Group II) when compared to the control group (p=0.039), along with a significant increase in AFP in Groups II and III when compared to Group I (P<0.001 for both). AFP also distinguished between the two HCV groups. The best generated cut off value for AFP was 10.9 ng/ml and for survivin 13.7 pg/ml. Serum survivin diagnostic sensitivity was 53.3%, diagnostic specificity 62.5% and efficiency 58.6%, in contrast to 100%, 92.5% and 95.7%, respectively, for AFP.
Conclusions: While survivin showed significant increase in the HCV group, its diagnostic performance was lower and it proved to be less reliable as a tumor marker for HCC than did AFP.