Background: Hepatocellular carcinoma [HCC] is a leading cause of cancer-related deaths worldwide, particularly in Egypt, where it ranks as the most common liver malignancy. Early detection of HCC is crucial for improving survival rates. Alpha-fetoprotein [AFP], the traditional biomarker for HCC, has limitations in sensitivity and specificity, particularly in early-stage detection. Calprotectin, a protein complex involved in inflammation and immune response, has shown potential as a novel biomarker, but its role in HCC diagnosis remains underexplored.
Aim of work: This study aims to evaluate the diagnostic value of serum and ascitic fluid calprotectin levels for the early detection of hepatocellular carcinoma in patients with liver cirrhosis.
Patients and methods: This prospective observational study included patients with liver cirrhosis, divided into two groups: those diagnosed with HCC and those without HCC. Serum and ascitic fluid calprotectin levels were measured using enzyme-linked immunosorbent assay [ELISA]. The diagnostic accuracy of calprotectin was assessed using receiver operating characteristic [ROC] curve analysis, and its performance was compared to AFP.   
Results: The study included 100 cirrhotic patients, 50 with HCC and 50 without. Calprotectin levels were significantly higher in both serum and ascitic fluid of HCC patients compared to non-HCC controls [p < 0.001]. ROC curve analysis demonstrated that ascitic calprotectin had a higher diagnostic accuracy [AUC 0.89, sensitivity 85%, specificity 88%] than serum calprotectin [AUC 0.85, sensitivity 80%, specificity 85%]. These findings indicate that calprotectin, particularly in ascitic fluid, is a more sensitive and specific biomarker for early HCC detection compared to AFP.   
Conclusion: Calprotectin levels in serum and ascitic fluid are promising biomarkers for the early detection of hepatocellular carcinoma in cirrhotic patients. Their superior diagnostic accuracy compared to AFP suggests potential utility in clinical practice, warranting further large-scale validation studies.