Predictive value of serum sex hormone binding globulin for the occurrence of hepatocellular carcinoma in male patients with cirrhosis

Background/Aims: The incidence of hepatocellular carcinoma is higher in males, presumably due to the influence of sex steroids. Therefore, to further assess the role of sex steroids in the occurrence of hepatocellular carcinoma, this study investigated the predictive value of different sex hormones and their binding protein. Methods: Among 101 male patients with cirrhosis included in a prospective screening study, 29 developed hepatocellular carcinoma. We assessed the predictive value of 17 clinico-biological and 4 serum hormonal variables collected at enrollment, by the log-rank test and the Cox model. Results: Age (p=0.003), bilirubin (p=0.04), sex-hormone-binding-globulin (p=0.003) and albumin (p=0.08) were predictive using the log-rank test, while estradiol and total and free testosterone were not. The Cox model showed age (p=0.003; relative RISK=7.52), sex-hormone-binding globulin (p=0.001, relative RISK=3.37) and albumin (p=0.02, relative RISK=2.94) as the most predictive parameters. Conclusion: We conclude that high serum sex-hormone-binding-globulin levels have an independent predictive value for the occurrence of hepatocellular carcinoma. Serum sex-hormone-binding-globulin could be used to define patients at high risk for hepatocellular carcinoma and could hypothetically play a role in hepatocarcinogenesis.