Evaluation of Serum Alpha-fetoprotein-L3 and Cytokeratin 19 as Biomarkers for the Early Detection of Hepatocellular Carcinoma and Treatment Response in Iraqi Patients

Abstract

Background: Hepatocellular carcinoma (HCC) is the most predominant kind of primary liver cancer and the third most cause of cancer-related mortality globally. In Iraq, hepatocellular carcinoma is considered a major public health problem. Studies have indicated that the two main causes of the disease are chronic viral hepatitis (HBV and HCV), in addition to cirrhosis, with an approximate male-to-female ratio of 3:1, and that the disease is most prevalent among patients aged 41 to 60 years.
Objective: This study aimed to evaluate the efficacy of serum Alpha-fetoprotein-L3 (AFP-L3) and Cytokeratin 19 (CK19) as biomarkers for the early detection of HCC and assessment of treatment response in Iraqi patients. Materials and methods: This study was conducted among 150 participants aged between 35 and 65 years at Al-Yarmouk Teaching Hospital in Baghdad, Iraq, from 10 January 2026 to 30 June 2026. Three groups of participants were included: 50 healthy individuals (Group I), 50 untreated patients with HCC (Group II), and 50 treated HCC patients with transarterial chemoembolization or TACE (Group III). ELISA was used to measure serum levels of AFP-L3 and CK19.
Results: AFP-L3 levels were significantly higher in Group II (32.73 ± 7.16 ng/mL) than in Group I (0.68 ± 0.20 ng/mL), whereas AFP-L3 levels in Group III decreased significantly to 10.86 ± 1.73 ng/mL compared with Group II (32.73 ± 7.16 ng/mL) (P < 0.0001). Regarding CK19 levels, Group II showed significantly increased levels (24.94±7.59 ng/mL) compared with Group I (3.87 ± 0.55 ng/mL). However, a marked reduction in CK19 levels was noted in Group III (8.12 ± 3.35 ng/mL) compared with Group II (24.94±7.59 ng/mL) (P < 0.0001).
Conclusion: Both AFP-L3 and CK19 demonstrated excellent diagnostic performance as independent biomarkers for early detection of HCC and assessment of treatment response in Iraqi patients