Yan Zhang,1 Jing Wu,1 Huaizhong Cui,1 Xiaojing Zhang,2 Lingyan He,1 Kailong Gu,1 Aifang Xu1 

1Department of Clinical Laboratory, Hangzhou Xixi Hospital, Hangzhou Sixth People’s Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 2Department of hepatology, Hangzhou Xixi Hospital, Hangzhou Sixth People’s Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China

Correspondence: Aifang Xu, Department of Clinical Laboratory, Hangzhou Xixi Hospital, Hangzhou Sixth People’s Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hengbu Street No. 2, Hangzhou, Zhejiang, 310023, People’s Republic of China, Fax +86-10-86481822, Email xuaifangxxh@163.com

Background: Liver cancer ranks among the most prevalent and lethal malignancies worldwide, with metastatic malignant ascites being a common complication. This study seeks to assess the diagnostic significance of high fluorescent cells (HFCs), biochemical and tumor markers in predicting the development of metastatic malignant ascites in patients with liver cancer.
Methods: We collected ascites samples from 266 patients diagnosed with liver cancer. HFC were analyzed using the BF mode of the BC-7500 hematology analyzer, assessing both relative counts (HF-BF%) and absolute counts (HF-BF#). Additionally, biochemical and tumor markers were evaluated in serum and ascites. The diagnostic accuracy of these indicators, both individually and in combination, was assessed using receiver operating characteristic (ROC) curve analysis.
Results: The malignant ascites group exhibited significantly higher levels of HF-BF%, cancer ratio 2 (Ratio2, ascites LDH: ascites ADA Ratio), and neuron-specific enolase (NSE) compared to the benign group, identifying these markers as independent risk factors for malignant ascites in liver cancer patients. Ratio2 demonstrated limited diagnostic value for malignant ascites, with an area under the curve (AUC) of 0.614. In contrast, HF-BF% and NSE showed moderate diagnostic capabilities, with AUCs of 0.760 and 0.700, respectively. The combined assessment of all three indicators yielded a high diagnostic capability, with an AUC of 0.824. The critical values for NSE, HF-BF%, and Ratio2 were 11.42 U/mL, 4.35/100 WBC, and 32.82%, respectively.
Conclusion: The combined evaluation of HF-BF%, Ratio2, and NSE serves as a valuable indicator for predicting the occurrence of metastatic malignant ascites in liver cancer patients.

Keywords: liver cancer, malignant ascites, high fluorescent cells, ascites LDH: ascites ADA ratio, NSE