Background: Angiopoietin-like proteins (ANGPTL) proteins play crucial functions in inflammation, lipid metabolism, hematopoietic stem cell activity, as well as cancer cell invasion. This research aimed to evaluate the levels of serum ANGPTL3 in hepatocellular carcinoma (HCC) patients before and after locoregional therapy intervention and to explore if their levels can be utilized in the follow-up of these patients following treatment.

Methods: a case-control study included 50 individuals divided into two groups; the Control group included 25 patients who had chronic liver disease secondary to hepatitis B or C without HCC. The case group included 25 naive HCC patients who were indicated to locoregional therapy (LRT) according to Barcelona Clinic Liver Cancer (BCLC) staging (stage A & B). Serum angiopoietin-like protein 3 level was measured using immunoassay ELISA kit and re-evaluated one month later following intervention.

Results: The HCC group had significantly higher levels of ANGPTL-3 than cirrhotic patients without HCC with a P value <0.001. The best cutoff of AGPTL-3 in the diagnosis of HCC was ≥8.33 ng/ml (p<0.001). the best cutoff of ANGPTL-3 after treatment for prediction of non-viable tumor was 13.91 ng/ml (p<0.001). ANGPTL-3 level >13.19 ng/ml significantly and independently increased the risk of viable/equivocal tumor's response to LRT by 109.6 folds with a p-value of 0.002.

Conclusion: Serum ANGPTL-3 level could serve as a new biomarker to screen for HCC among patients with cirrhosis and could be a possible follow-up marker in the assessment of interventional therapeutic response among HCC patients.