Circulating HOTAIR potentially predicts hepatocellular carcinoma in cirrhotic liver and prefigures the tumor stage

Aim of the study
Homeobox transcript antisense intergenic RNA (HOTAIR) is a long non-coding RNA classified as an oncogene and has been implicated in liver cancer initiation and progression. This study investigated the clinical usefulness of serum HOTAIR to predict hepatocellular carcinoma (HCC) and prefigure the tumor stage.

Material and methods
This study included 80 patients with de novo HCC divided into 40 late-stage HCC patients (group IA) and 40 early-stage HCC patients (group IB), 40 patients with non-tumorous liver cirrhosis (group II), and 20 healthy controls (group III). Serum HOTAIR was measured using real-time quantitative polymerase chain reaction. Serum a-fetoprotein (AFP) was measured via enzyme-linked immunosorbent assay.

Results
Serum HOTAIR was significantly higher in groups IA, IB and II compared to healthy subjects. Serum HOTAIR was significantly higher in group IA than group IB, and in groups IA and IB compared to group II. Serum HOTAIR at cut-off value > 15.45 (AUC = 0.71) showed 66% sensitivity and 78% specificity in discriminating HCC patients of group IB from HCC patients of group IA. When combined with AFP, the discriminative sensitivity and specificity increased to 74% and 90% respectively (AUC = 0.85). Serum HOTAIR at cut-off value > 9.42 (AUC = 0.823) showed 67.5% sensitivity and 93.3% specificity in discriminating HCC patients of group IB from patients with non-tumorous cirrhotic liver. When combined with AFP, the discriminative sensitivity and specificity increased to 80% and 98.3% respectively (AUC = 0.954).

Conclusions
Circulating HOTAIR is a potential biomarker which may be used solely, or preferably in combination with AFP, to help HCC detection in cirrhotic liver and prefigure the tumor stage.