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The Diagnostic role of Soluble (sAxl) Level in Patients with Hepatocellular Carcinoma compared to Alpha-fetoprotein

Background and Aim: Hepatocellular carcinoma deemed for the plurality of primary liver cancers. Malignancy of the liver is the fourth most popular etiology of cancer mortality worldwide. The high mortality of HCC cases is linked to the delay in diagnosis. Aberrant expression of Axl frequently occurs in many malignancies and is critical for promoting cell proliferation, migration, angiogenesis and metastasis. Axl deregulated activation or expression is linked to resistance to targeted cancer therapies. we aimed to to clear up the diagnostic role of sAXL in HCC patients. 
Methods: Study included 90 participants; 40 HCC patients on top of liver cirrhosis, 30 patients with liver cirrhosis and twenty healthy subjects (controls). CBC, liver and kidney function tests, alpha-fetoprotein, abdominal ultrasound and triphasic CT were performed. sAxl was assessed by ELISA. 
Results: sAxl was considerably higher in HCC patients than in cirrhotic and control participants (p 63.5, AFP at cut off >40.34 has sensitivity, specificity and AUC 57.5%, 60% and 0.675 respectively. The combination of AFP and sAxl at related cut off points has higher sensitivity (97.5%) and AUC 0.972 in predicting HCC in cirrhotic patients. sAxl was positively correlated with tumor size. 
Conclusion: sAxl outperforms AFP in detecting HCC, especially in early HCC and in AFP-negative HCC. Combination of sAxl with AFP improved the sensitivity for early HCC diagnosis.