Procalcitonin as a potential tumor marker for fibrolamellar hepatocellular carcinoma: Insights from three patients and a literature review.

Fibrolamellar hepatocellular carcinoma (fHCC) was diagnosed through magnetic resonance imaging in three young patients (with biopsies confirming the diagnosis in two of them prior to referral) aged 17, 22, and 24 years. All had normal or near-normal standard biochemistry results, except for increased levels of procalcitonin (PCT) and C-reactive protein (CRP) in the absence of any infectious source: PCT: 41, 5.8, and 1.2 ng/mL, respectively (normal range < 0.05 ng/mL) and CRP: 127, 21, and 14 mg/L, respectively (normal range: 0-5 mg/L). Right hepatectomy with negative surgical margins resulted in the eventual normalization of CRP levels in all patients, and PCT levels normalized in the latter two patients. The PCT level was 0.07 ng/mL at 3 months in the first patient. The emergence of two bone metastases in the rib and right femur at 7 months was accompanied by an increase in PCT levels to 0.8 ng/mL. Radiotherapy provided transient control in the femur only. Consequently, a thoracic wall resection was performed, followed by a segmental resection of the femur. Treatment with bevacizumab at a dose of 15 mg/kg/day and atezolizumab at 1200 mg/day every 21 days was started. A PET-CT scan conducted at the 42nd month showed no signs of recurrence, and the PCT level was 0.04 ng/mL. The other patients exhibited normal PCT levels and no evidence of recurrence at 16- and 6-months post-treatment. Since PCT measurement is routinely available, baseline levels should be measured at least once during the workup of patients with fHCC.