Plasma Long Non-Coding RNA ZFAS1 as a Potential Diagnostic Biomarker for HCV-Related Hepatocellular Carcinoma

Abstract—Hepatocellular carcinoma (HCC) represents the sixth most common cancer worldwide. Cirrhosis induced by hepatitis-C virus (HCV) infection is a key risk factor for HCC. ZNFX1 antisense RNA 1 (ZFAS1), a novel long non-coding RNA (lncRNA) was found to be increased in multiple cancers contributing to cancer development and progression. We aimed to evaluate the expression profile of plasma ZFAS1 in HCV-related HCC and explore its relation to HCC stage. Plasma from 20 HCV-related liver cirrhosis patients without HCC, 60 HCV-related HCC patients with underlying cirrhosis and 20 healthy controls was collected. Subsequently, relative quantification of ZFAS1 lncRNA expression was performed using quantitative real time-polymerase chain reaction. Expression level was significantly higher in HCC compared to cirrhotic patients (p = 0.017). Meanwhile, the area under the receiver operating characteristic curve (AUC) of ZFAS1 expression was 0.700 (95% confidence interval: 0.564–0.836) to differentiate HCC from cirrhotic patients, while that of serum alpha fetoprotein (AFP) was 1.000 (95% confidence interval: 1.000–1.000). Interestingly, there was a positive correlation between ZFAS1 relative expression and Child Pugh classification in HCC group (p = 0.039). In conclusion, our results indicated that ZFAS1 could be a good diagnostic marker to distinguish HCC from cirrhotic patients with adequate sensitivity and specificity.